Pennsylvania Fraud Stories - Pennsylvania Insurance Fraud

Pennsylvania Fraud Stories
SEPTEMBER 2015
Pennsylvania
Insurance Fraud Prevention
Authority
Message from the Executive Director
Welcome to the September edition of our newsletter. I’m writing this after
returning from the International Association of Special Investigation Units
(IASIU) Conference in Orlando, FL. Congratulations to Wade Wickre, President, along with the officers and directors of IASIU for a terrific conference.
To me, one of the most important aspects of attending a conference is net-
Inside this issue:
working and building relationships. The people whom you meet at a conference can provide valuable assistance to you, and you to them, as you progress
Public Relations
2
through your career.
Know the Risks!
3
Owner of PSK Auto
3
Body Faces More
I mention networking and relationship building because I believe it is one of
Ralph Burnham
Thomas
Donahue
the most important aspects in fighting fraud. Collaboration and cooperation
Executive
Director
IFPA
Executive
Director
among SIUs and law enforcement is vital in combating insurance fraud in Penn-
Charges
sylvania. One of the best ways to develop this cooperation is to establish relationships among the SIUs
Multiple Claims Filed
4
and law enforcement by attending a local IASIU chapter meeting where SIUs and law enforcement can
network prior to and following the meeting. It is a great opportunity to put a face with a name. Taking
for Same Damage
Claims Filed Against
place on April 7th and 8th 2016 at the Hershey Lodge & Convention Center in Hershey, PA is the IFPA
and IASIU’s annual fraud conference, which will also provide an excellent opportunity to network with
Verizon
other SIUs and law enforcement.
Bogus Slip-and-Fall
House Fire Leads to
5
6
Renter’s Vision of Profit
Know the Penalties!
7
Mark Your Calendar!
14
Who to Call
15
We are happy to announce that our fall public relations campaign is underway. Beginning the week of
September 28th we began broadcasting our radio commercials on the major radio stations in the Philadelphia market. On October 1st, we unveiled our new website design with new videos focusing on what
leads people to commit insurance fraud and what are the consequences after being caught. Our media
research revealed that younger adults do not like to obtain their information through reading, so we are
focused on creating fun and edgy videos to attract people to our website: http://www.helpstopfraud.org/
We have also launched our new You Tube site “Idiots, Liars, and Losers. See How They Lie” where our
videos will also be housed. We are using digital advertising and social media to direct people to the new
You Tube site. As mentioned above, the videos will be more fun and edgy than those in the past and will
depict fraud schemes from around the state. Some of the video titles are “Shameless in Somerset”,
“Clueless in Clearfield” and “Greedy in Gettysburg”. Check out our You Tube site at: https://
www.youtube.com/channel/UChyfe545e0gD_OwElPI159w
You can also access You Tube from our website as well by clicking on “Watch Even More Dumb Plots”
just beneath the featured video.
Please take a look at our new sites and pass them along to your coworkers, families and friends.
As always, thank you for all that you do in fighting insurance fraud in Pennsylvania!
Page 2
Public Relations
Winning! In the war against insurance fraud, that is. PA Fraud Fighters’ work generate the cases from which
we draw our fraud prevention messages. We’re pleased to see that Pennsylvania’s series of award winning
fraud prevention videos are now available to all insurers, state fraud bureaus and anti-fraud groups, at little
or no cost, through the national Coalition Against Insurance Fraud. Contact Kendra Smith at 202-393-7330.
Perhaps you’ve seen the TV spot where a young lady in a job interview finds
herself in the difficult position of having to admit that she’d been arrested
for insurance fraud. She blurts out that she’d gotten mixed up in a faked
injury scheme and was fined and put on probation. The message is clear, that
bad decision is going to haunt her for the rest of her life.
Or, maybe you’ve seen the TV ad where a man takes notice of the progress of his neighbor’s home repairs.
A hail storm, a storm-chasing fly-by-night contractor, improperly done repairs and mechanics liens placed on
the property were the ingredients of this spot’s message to consumers to be wary
of deals that sound too good to be true.
Would our posters or brochures assist your fraud prevention and fraud awareness training efforts?
View our online store and order—there’s no cost or charge.
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 August 4, 2015, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 44
year-old Darryl Sewell of Philadelphia, PA and charged him with three counts each of Insurance Fraud and
Theft by Deception. Sewell, who is the owner of PSK Auto Body was arrested previously in November
2013 and June 2015 for allegedly cashing insurance claim checks but failing to properly repair vehicles
brought into the body shop for repairs. According to the most recent criminal complaint, Sewell cashed
insurance claim checks from three different customers but did not fix or return the vehicles. Sewell reportedly received a $3,300 check from Erie Insurance Company, a $3,700 check from Allstate Insurance
Company and a $6,300 check from GEICO Insurance Company for the repairs of three vehicles. According to the complaint, detectives interviewed all three of the vehicles’ owners who reported that when they
finally retrieved their vehicles, they were in worse condition than when they left the vehicles at PSK Auto
Body for repair. Detectives verified that Sewell had received and cashed each claim check from documents
showing photographs of Sewell cashing each check as well as images of the checks themselves. [OTN:
N9737932]
On August 4, 2015, from a referral received from Progressive Insurance Company, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed two Criminal Complaints charging
37 year-old Michael Shoenberger of Clifton Heights, PA with Insurance Fraud, Theft by Deception-False
Impression, Forgery, Receiving Stolen Property, Criminal Use of Communication Facility and four counts
of Conspiracy; and 42 year-old Raymond W. Berstler of Morton, PA with Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property and five counts of Conspiracy. According to the complaints, on February 11, 2013, a claim was made via telephone to Progressive regarding a two-vehicle crash
involving a 2010 Dodge R1500 TRX pickup truck. The caller identified himself as policy holder David
Busby, and reportedly stated that as he was operating his truck, he lost control on an icy road and struck a
tree. Progressive issued a check for $7,138.48 made payable to David Busby and Ray’s Tire & Automotive
only and the check was given to Michael Shoenberger who stated that he was the manager of Ray’s Tire &
Automotive. According to the complaint, Busby had been reviewing his auto insurance policy online when
he discovered there had been a claim filed on his policy that he had not made, nor had he given authorization for anyone to make. The complaint reflects that upon further investigation, it had been alleged that
Shoenberger and Berstler filed a claim while claiming to be Busby and then forged Busby’s signature on the
Progressive claim check, defrauding Progressive in the amount of $7,138.48. [OTN: T6851331, T6851025]
On August 5, 2015, Office of Attorney General special agents filed a Criminal Complaint in Delaware
County charging 37 year-old Jacqueline S. Fox of Philadelphia, PA with two counts of Insurance Fraud and
one count each of Theft by Deception-False Impression, Criminal Attempt Theft by Deception-False Impression and Forgery. According to the complaint, Fox applied for a loan with Springleaf Financial Services
and for disability insurance coverage for the loan with Merit Life Insurance Company on May 10, 2012.
On the application, Fox reportedly stated that she was currently employed by the Philadelphia Prison System working 80 hours per pay period at an hourly rate of $18.66. Fox subsequently filed a disability claim
with Merit Life alleging that she became disabled and stopped working less than three months after applying for the loan and disability insurance coverage. The complaint reflects that an investigator employed by
Body Shop
Owner Charged
Again
Page 4
Know the Risks, Know the Penalties
Fraud Stories (Continued)
Merit Life obtained documentation from the City of Philadelphia which showed that Fox had been on unpaid disability leave since June 30, 2011 and had not been paid by the Prison System during her one-year
medical absence from June 30, 2011 to June 30, 2012. Further investigation revealed that Fox had been disabled, had not worked and had not been employed for approximately one year before applying for the loan
and disability insurance coverage and according to the complaint, Fox later admitted to lying about her employment status and to lying about when she had become disabled. According to the complaint, Fox obtained
proceeds from the loan and attempted to collect $3,630 in disability benefits to which she was not entitled.
[OTN: T6857900]
On August 10, 2015, from a referral received from Progressive Insurance Company, Office of Attorney General special agents filed a Criminal Complaint in Berks County charging 50 year-old Michele Mogel of Womelsdorf, PA with three counts of Insurance Fraud, two counts of Theft by Deception-False Impression and one
count each of Criminal Attempt Theft by Deception-False Impression and Forgery. According to the complaint, on July 10, 2013, Mogel was involved in an auto accident when her 2002 Dodge Durango was struck
“...Mogel had filed
multiple claims in an
attempt to receive
payment for damage she
had already been
compensated for.”
by another motorist. As a result of the collision, Mogel’s Durango sustained damage to the driver’s side doors,
and the individual who struck Mogel’s Durango was insured with Progressive Insurance Company. Mogel
subsequently filed a claim with Progressive and photographs of the damage to Mogel’s Durango were taken.
Progressive provided Mogel a check in the amount of $1,832.15 to have the damage repaired. Mogel later
filed two more claims, one on October 10, 2013 and the other on February 3, 2014, with 21st Century Indemnity Insurance Company to report that her Durango had been struck and had sustained damage to the
driver’s door in both instances. 21st Century paid Mogel $2,061.37 for her October 2013 claim and $1,739.15
for the February 2014 claim. Finally, on September 26, 2014, Mogel filed yet another claim in the amount of
$1,560.16 with Progressive for the same type of damage to the Durango; however, Progressive denied the
claim when Mogel’s previous claims were discovered. According to the complaint, it had been alleged that
Mogel had filed multiple claims in an attempt to receive payment for damage she had already been compensated for. From the first three claims Mogel submitted, she received some $5,632.72 in total claim payments
but failed to have the damage to the Durango repaired. [OTN: T6874280]
On August 12, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint
charging 30 year-old Matthew A. Keller of Etters, PA with Workers’ Compensation Insurance Fraud and
Criminal Attempt Theft by Deception-False Impression. According to the complaint, on July 10, 2014, Keller
claimed that he was injured while helping his cousin lift heavy objects and was diagnosed with a hernia by
PinnacleHealth Harrisburg Campus staff. On October 24, 2014, Keller reported to his employer, Monarch
Products Co. Inc., that he was struck and injured by a mold handle while working. A workers’ compensation
claim with Penn National Insurance Company on behalf of the defendant was filed. According to the complaint, upon further investigation, it was alleged that Keller’s claim of having been injured while at work was
fraudulent as it was the same injury he’d sustained in July 2014. [OTN: T6903713]
On August 12, 2015, Office of Attorney General special agents filed a Criminal Complaint in Montgomery
County charging 24 year-old Alton Williams of Philadelphia, PA with six counts of Insurance Fraud and three
counts of Attempted Theft by Deception-False Impression. According to the complaint, on May 24, 2015,
Williams obtained an Allstate Insurance and GEICO Insurance auto insurance policy for a 2000 Mercury
Sable he claimed to own. Subsequently, on that same day, Williams reported to Allstate that his car had been
struck by another vehicle, and reported to GEICO that his car had been stolen. Then, on May 29, 2012, Williams obtained a Liberty Mutual Insurance policy for the 2000 Mercury Sable and later that day reported that
the car had been involved in an accident. According to the complaint, it had been alleged that the 2000 Mer-
Know the Risks, Know the Penalties
Page 5
Fraud Stories (Continued)
cury Sable that Williams had insured was actually owned by someone else and that Williams never had possession of the vehicle. Further, the vehicle’s true owner reportedly stated that she did not know Williams. The complaint reflects that Williams had not been paid for any of the three claims he filed. [T6885185]
On August 18, 2015, from a referral received from Allstate Insurance Company, Office of Attorney General
special agents filed a Criminal Complaint in Montgomery County charging 27 year-old Shakyrah Laurae Barnett
of Philadelphia, PA with Insurance Fraud, Criminal Attempt Theft by Deception-False Impression and Unsworn
Falsification. According to the complaint, it was alleged that Barnett had claimed she was a passenger in her
mother’s 2000 Mazda Protégé, insured with Allstate, when her mother was involved in an auto accident and
sustained injuries as a result. Barnett later submitted documents and medical bills to Allstate; however, Allstate
had not paid the claim as it was reportedly revealed that Barnett had not been in her mother’s vehicle at the time
of the accident. [OTN: T6905953]
On August 24, 2015, from a referral received from Sedgwick Claims Management, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 40 year-old Rasoul A. Salim and 25 year-old Kortney M.
Burton, both of Philadelphia, PA. Salim was charged with Criminal Attempt Theft by Deception-False Impression, Conspiracy, False Swearing and False Reports. Burton was charged with Theft by Deception-False Impression, Conspiracy and False Swearing. According to the Criminal Complaints, Salim filed personal injury claims
against Verizon for two separate slip-and-falls in 2013, one in May and the second in November. Detectives reportedly obtained medical records which showed Salim had received eight months of treatment from Northwest
Medical and Rehab Center for the injuries he claimed to have sustained as a result of the alleged May fall. According to the complaint, a Sedgwick claim file for Salim also included documents from the November claim
Salim filed against Verizon in which Salim retained a different attorney to represent him and sought medical
treatment at Cottman Castor Pain Management; however, during Salim’s testimony at an arbitration hearing
regarding the first claim, Salim reportedly denied ever falling in front of the Verizon building in November 2013
and that he ever sought treatment at Cottman and Castor Pain Management. In addition to Salim’s two claims,
Sedgwick received a claim for Burton as well, who also alleged that he had slipped and fallen in June 2013. Both
reportedly denied having any knowledge of each other’s slip-and-fall claim; however, detectives were able to retrieve phone records for both defendants which showed 41 calls and 36 text messages between the two from
June 15, 2013 and June 29, 2013. The complaint reflects Salim’s claim had been denied but that Sedgwick had
paid Burton $25,000 to settle his claim. [OTN: N9763250, N9763493]
On August 24, 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal
Complaint in Luzerne County charging 62 year-old Roger Francis Thomas of Kingston, PA with two counts
each of Insurance Fraud and Theft by Deception. According to the complaint, Thomas obtained an auto insurance policy with Safe Auto Insurance Company on March 11, 2015 at 5:13 PM to insure a 2013 Chevrolet
Malibu. The complaint states that Thomas was involved in a two-vehicle accident on March 11, 2015 at 4:20
PM, prior to obtaining the Safe Auto policy. It was alleged that Thomas, in reporting the accident to Safe Auto, provided false and misleading information in support of the claim to reflect that the accident occurred after
he’d obtained the Safe Auto policy. According to the complaint, as Thomas was not insured at the time of the
accident, Allstate Insurance Company had paid its insured $1,301.23 to cover his vehicle’s damage as a result
of the accident. [OTN: T6928681]
On August 26, 2015, detectives of the Allegheny County Police Department filed two Criminal Complaints
charging 36 year-old Thomas Shray of Pittsburgh, PA with Insurance Fraud. According to the complaints, Shray
filed a claim with Safe Auto Insurance Company for key scratch damage to his 2012 Kia Sorento that occurred
on January 31, 2015. Safe Auto issued payment in the amount of $3,503.66 to Shray to repair the damage. It
Two Alleged to
Have Filed
Bogus Slip-andFall Claims
Against
Verizon
Page 6
Know the Risks, Know the Penalties
Fraud Stories (Continued)
was then discovered by a Safe Auto special investigator that Shray had claimed similar damage to State Farm
Insurance Company on December 18, 2014 and had received $2,478.75 from State Farm for repairs. According to the complaints, photos of the damage from both claims reportedly showed similar damage. The complaint states that Shray filed yet another claim on March 29, 2015 for key scratch damage to his vehicle; however, no payment was issued to Shray for the March 2015 claim as it had been alleged that in all three claims, the
damage Shray reported was the same and that Shray had received claim funds from both Safe Auto and State
Farm but never had the damage from either claim repaired. [OTN: G7203453, G7203490]
On August 26, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint
charging 32 year-old Tomasina L. Hanna of York, PA with two counts of Insurance Fraud and one count of
Criminal Attempt Theft by Deception-False Impression. According to the complaint, Hanna was involved in a
two-vehicle crash on July 27, 2015. The driver of the other vehicle took a photo of Hanna’s vehicle, and the
complaint states that metadata from the photograph showed the photo was taken at 12:38 PM. Reportedly,
Hanna did not have a valid insurance policy for her vehicle at the time of the accident as she had not contacted
“According
to the
complaint, Hanna
admitted that she had
purchased the Safe Auto
policy after the accident
had occurred and that
she had lied about the
time of the accident
when she filed the
claim.”
Safe Auto Insurance Company until approximately 12:48 PM to obtain coverage for her vehicle. Subsequently
at approximately 2:03 PM, Hanna reportedly contacted Safe Auto to file a claim for the accident that occurred
ten minutes prior to her obtaining a valid insurance policy with Safe Auto. According to the complaint, Hanna
admitted that she had purchased the Safe Auto policy after the accident had occurred and that she lied about
the time of the accident when she filed the claim. The complaint states that the driver of the other vehicle
involved in the crash paid $500 out of pocket to have her vehicle repaired and Erie Insurance Company paid
an additional $313 to complete the work to her vehicle. [OTN: T6942832]
On August 27, 2015, detectives of the Lehigh County District Attorney’s office filed two Criminal Complaints
charging both 51 year-old Myrna Salguero and 25 year-old Katherin Vazquez-Rosado, both of Allentown, PA
with Insurance Fraud and Conspiracy. According to the complaints, on January 8, 2015, Vazquez-Rosado on
behalf of Myrna Salguero, notified Titan (Nationwide) Insurance Company that Salguero had been involved
in a motor vehicle accident while operating a 2002 Honda Odyssey which was registered to Vazquez-Rosado
but insured by Myrna Salguero, the only listed driver on the policy. Further investigation revealed that Vazquez
-Rosado was driving the vehicle at the time of the crash, and that she and Salguero had conspired to file the
claim and report that Salguero had been driving at the time of the crash as Vazquez-Rosado was not a listed
driver on the auto insurance policy. [OTN: L9647735, L9647676]
On August 31, 2015, from a referral received from Erie Insurance Company, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint in Lackawanna County charging 49 year-old
Karen Lyn Fabri of Jessup, PA with Insurance Fraud and Attempted Theft by Deception-False Impression.
Fabri initiated a claim on December 10, 2014 regarding the loss of personal belongings from a November 26,
2014 fire that burned the house she was renting, and provided Erie with a notarized proof of loss which listed
that two bedroom sets, a dining room set and living room furniture and numerous other belongings to include
a two carat diamond engagement ring were destroyed in the fire. According to the complaint, the list was forwarded to Fabri’s estranged husband as he was listed on the policy, and reportedly, Mr. Fabri advised that the
list Ms. Fabri provided was fraudulent as most of the items were either not owned by Ms. Fabri or not in her
home at the time of the fire, and further that the two carat diamond engagement ring was in fact a half carat.
Subsequently, on April 24, 2015, Ms. Fabri’s attorney reportedly notified Erie’s attorney that Ms. Fabri wished
to withdraw her claim. No payment was made to Fabri. [OTN: T6960380]
Know the Risks, Know the Penalties
The Penalties:
Page 7
The following dispositions of cases previously reported on were obtained via
the web portal of Pennsylvania’s Unified Judicial System.
On August 4, 2015, a Philadelphia, PA woman was granted ARD with 12 months' probation and was ordered to perform 10 hours of community service and to pay a $500 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs of $1,349.50. The defendant had been arrested in December 2014 by
Office of Attorney General special agents and was charged with Insurance Fraud, Theft by Deception, Criminal Attempt Theft by Deception and two counts of Forgery. According to the Criminal Complaint, the defendant was employed by Concept-Resources for Human Development (RHD) until March 29, 2011, when
she voluntarily resigned. On April 29, 2011, the defendant allegedly applied for and purchased an Involuntary Unemployment Insurance policy from Merit Life Insurance. According to the complaint, the defendant
stated on her application that she was currently employed. On July 12, 2012, the defendant filed a claim with
Merit Life, in which she allegedly maintained that she was involuntarily laid off from RHD on April 10,
2011. An investigation revealed that she had allegedly forged documentation from her former employer,
RHD, and submitted the documents to Merit Life in support of her claim. [OTN: T6008225]
On August 5, 2015, James Robert Lesoine of East Stroudsburg, PA pled Guilty to Insurance Fraud and was
sentenced to serve 12 months' probation and was ordered to pay court costs totaling $1,274. Lesoine was
arrested by Office of Attorney General special agents in December 2014 and charged with Insurance Fraud
and Criminal Attempt Theft by Deception. According to the Criminal Complaint, Lesoine had a Nationwide Insurance automobile policy for his 2005 Dodge pickup truck. On April 9, 2012, Lesoine allegedly
contacted Nationwide and submitted a claim for damages which purportedly occurred when Lesoine’s pickup
truck rear-ended another vehicle. Lesoine allegedly claimed that he was on his way to apply for a landscaping
job when the accident happened. According to the complaint, investigators determined that Lesoine already
was employed by the landscaping company and had been driving a work truck at the time of the accident.
The work truck was not covered under Lesoine’s personal policy. [OTN: T6004736]
On August 6, 2015, from a Non-Negotiated Guilty plea to Theft by Failure to Make Required Disposition of
Funds, Gregory Spitz of Aston, PA was sentenced to serve 23 months' in an Intermediate Punishment Program followed by seven years' probation and was ordered to pay $138,579.03 in restitution and $5,815 in
court costs. Spitz was additionally ordered to perform 120 hours of community service. On March 24, 2015,
Office of Attorney General special agents filed a Criminal Complaint charging Spitz with Theft by DeceptionFalse Impression and Theft by Failure to Make Required Disposition of Funds. According to the complaint,
Spitz was an insurance agent with an active individual resident producer’s license with the Pennsylvania Insurance Department. It was alleged that between October 1998 through August 2013, Spitz had collected
premiums for active life insurance policies in the amount of $138,579.03, but failed to remit the premiums
to Columbian Life Insurance Company. According to the complaint, Columbian Life was forced to pay out
benefits on two death claims for two lapsed policies due to the misappropriation of premiums by Spitz, and
that both of those policies had lapsed without the knowledge or consent of the policy owner. [OTN:
T6348311]
On August 6, 2015, a Greensburg, PA woman was granted ARD with 12 months' probation and was ordered
to pay $75 in restitution and $1,095.50 in court costs. On December 17, 2014, Office of Attorney General
special agents arrested the defendant and charged her with Insurance Fraud and Pharmacy Act Violation.
According to the Criminal Complaint, the defendant was employed as a Rite Aid pharmacist from June
Insurance
Agent
Sentenced to
Serve 23
Months’ in an
Intermediate
Punishment
Program and
Ordered to Pay
Restitution
Totaling
$138,579.03
Page 8
Know the Risks, Know the Penalties
Fraud Stories (Continued)
2013, through March 2014. During that time period, it is alleged that she had filled 26 prescriptions for Butalbital/Fiorcet, a medication used to treat migraine headaches. The prescriptions were purportedly authorized
by David Regalla, a physician’s assistant. However, according to the complaint, Regalla confirmed that he did
not authorize the prescriptions, which had been submitted for payment to OptumRx, third party administrator for Highmark Insurance. [OTN: T6006350]
On August 10, 2015, from a Negotiated Guilty plea to Criminal Attempt Theft by Deception-False Impression, Alvinia Patrice Barnes of Lancaster, PA was sentenced to serve 12 months' probation and was ordered to
pay court costs totaling $694.50. Office of Attorney General special agents arrested Barnes on April 30, 2015
and charged her with Insurance Fraud and Criminal Attempt Theft by Deception. According to the Criminal
Complaint, Barnes submitted a claim to Progressive Insurance Company on April 9, 2011, in which she
asserted that her vehicle was struck by a neighbor’s vehicle which was insured by Progressive. The complaint
stated that Progressive completed an estimate and took photos of the damage to the front bumper cover of
Barnes’ vehicle, but noted that damage to the left front quarter panel and left rear door appeared to be preexisting. According to the complaint, Progressive issued payment directly to Barnes in the amount of $121.90
for the damage to the front bumper. On November 30, 2011, Barnes submitted a claim to her own insurer,
ARD &
Probation in
Auto Insurance
Fraud Cases
Nationwide Insurance Company, in which she allegedly stated that someone broke into her car and stole her
stereo and Christmas gifts. According to the complaint, Nationwide issued payment to Barnes in the amount
of $425.23 for damages to the vehicle, including damage to the outer edge of the roof, torn weather stripping
and scratch marks. The complaint further stated that photographs taken during the claim process revealed
damage to the vehicle’s left rear door and left quarter panel. On February 16, 2012, Barnes submitted another
claim to Nationwide in which she allegedly reported that a hit and run driver had struck her parked vehicle,
damaging her vehicle’s left quarter panel and left rear door. According to the complaint, a Nationwide adjuster reviewed photos of the vehicle taken at the time of Barnes’ previous Nationwide claim, and determined that
the newly-claimed damage was pre-existing. [OTN: T6485916]
On August 11, 2015, a Darby, PA woman was granted ARD with 12 months' probation and was ordered to
pay a $250 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs of $1,220. The defendant was arrested in December 2014 by Office of Attorney General special agents and charged with Insurance
Fraud and Criminal Attempt Theft by Deception-False Impression. According to the Criminal Complaint, the
defendant purchased a liability only automobile policy from Allstate Insurance Company on July 25, 2012.
On February 15, 2013, the defendant contacted Allstate at 2:47 PM to add collision, comprehensive, rental
and roadside assistance coverage to her policy. The defendant contacted Allstate again at 5:20 PM on the 15th
to file a claim for an accident which she alleged had occurred at 3:00 PM that day. However, Allstate had obtained a copy of the Upper Darby Police Department’s report of the accident which revealed that the crash
had occurred before she had added the coverage to her policy. [OTN: T6007551]
On August 11, 2015, Alicia Colleen Kassakatis of Hanover, PA pled Guilty to Attempted Theft by DeceptionFalse Impression and was sentenced to serve two years' probation and was ordered to pay court costs of
$740.50. Detectives of the York County District Attorney’s office filed a Criminal Complaint on March 25,
2015 charging Kassakatis with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on January 3, 2014, Kassakatis obtained an auto insurance policy of GEICO Insurance
Company to insure a 1998 Oldsmobile Cutlass. On February 3, 2014, the defendant filed a claim with GEICO alleging that she had been involved in a single-vehicle accident earlier in the day; however, it was alleged
that the damages to Kassakatis’ vehicle were the result of a crash the defendant had been involved in on De-
Know the Risks, Know the Penalties
Page 9
Fraud Stories (Continued)
cember 11, 2013, and that Kassakatis had not had a valid insurance policy when the December 2013 accident
occurred. According to the complaint, on March 23, 2015, the defendant admitted that the damages to her
vehicle were not the result of a February 3, 2014 accident, and that she was attempting to obtain some
$1,582.78 from GEICO to repair the damages from the December 2013 accident. GEICO did not pay the
claim. [OTN: T6358015]
On August 12, 2015, from a Negotiated Guilty plea to Insurance Fraud, Jeffrey Michael Scott of Harrisburg,
PA was sentenced to serve 18 months' probation and was ordered to perform 25 hours of community service
and pay court costs of $1,645.01. In April 2015, detectives of the York County District Attorney’s office filed
a Criminal Complaint charging Scott with Insurance Fraud and Criminal Attempt Theft by Deception-False
Impression. According to the complaint, on August 29, 2013 at 11:20 PM, Scott reportedly filed a claim with
his insurer, Progressive Insurance Company, stating that his 2012 Nissan Sentra was damaged on August 29,
2013 when he struck a deer. Reportedly, however, the investigation revealed that the defendant’s vehicle had
been damaged on August 26, 2013, prior to Scott’s contacting Progressive to change his policy deductible
from $1,000 to $100 on August 27, 2013. It was alleged that Scott had misrepresented the actual date the
damage occurred to his vehicle so as to pay only the $100 deductible, which he obtained after the damage had
already occurred. [OTN: T6391604]
On August 12, 2015, from a Guilty plea to Arson, Brenhan James Skrak of New Castle, PA was sentenced to
“Nationwide paid
serve 12 months' confinement and ten years' probation, and was ordered to pay $223,639.70 in restitution
and court costs of $752. Office of Attorney General special agents, from a referral received from Nationwide
Skrak’s grandmother
Insurance Company, filed a Criminal Complaint in June 2014 charging Skrak with Insurance Fraud, two
counts of Arson and Attempted Theft by Deception-False Impression. According to the complaint, Skrak was
some $146,597 for her
living in his grandmother’s home while she was away on vacation. The home sustained heavy fire damage on
July 24, 2013, and Skrak’s grandmother filed a claim with her home’s insurer, Nationwide. Pennsylvania State
home’s damage and her
Police fire marshals as well as certified fire inspectors retained by Nationwide reportedly determined that the
fire was incendiary in nature and not the result of any electrical problems. According to the complaint, Skrak
fire loss.”
had stated to officers that he had left the home prior to the fire’s starting, to meet a friend. However, phone
records reportedly showed that Skrak was at the home after the time that he said he left the home, and the
Skrak’s friend stated that he had not seen Skrak that day. And, witnesses reportedly stated that they had seen
Skrak walking a short distance away from the home when they realized that the home was on fire. According
to the complaint, a computer, flat screen television and a dehumidifier, which Skrak reportedly pawned without his grandmother’s consent, had been removed from the home prior to the fire and an old television and
dehumidifier had been put in their place. Nationwide paid Skrak’s grandmother some $146,597 for her
home’s damage and her fire loss. [OTN: T4820432]
On August 12, 2015, a Philadelphia, PA woman was granted ARD with two years' probation and was ordered
to pay $1,500 in restitution and $418.50 in court costs. From a referral received from Sedgwick Claims Management which is third party administrator for Save A Lot supermarkets, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested the defendant in April 2015 and charged her with Insurance
Fraud, Criminal Attempt Theft by Deception-False Impression and False Swearing. According to the complaint, on October 25, 2012, the defendant was shopping at Save A Lot when she alleges she slipped on a
puddle of water near a meat case in the back of the store, injuring her back and leg. She had retained legal
counsel to represent her in a personal injury lawsuit against Save A Lot. Detectives retrieved surveillance footage from the Save A Lot which reportedly shows that the defendant was not injured while shopping in the
Page 10
Know the Risks, Know the Penalties
Fraud Stories (Continued)
store. The defendant is reportedly seen walking past a refrigerated meat case while headed towards a refrigeration box, pausing in front of the meat case and looking at the floor. Upon picking up milk from the refrigeration box, she is then seen walking to the front of the store and returning to the spill and taking photographs
with her cell phone before a Save A Lot manager met her at the area of the alleged incident. The defendant is
never seen slipping or falling on the surveillance video footage; therefore, Save A Lot did not pay the claim.
[OTN: N9584326]
On August 12, 2015, from a Guilty pleas to Workers' Compensation Fraud and Theft by Deception-False
Impression, Kyle C. Kent of Marion Heights, PA was sentenced to serve 23 months' confinement and was
ordered to pay $45,654.94 in restitution and court costs totaling $1,557. On October 20, 2014, Office of
Attorney General special agents had filed a Criminal Complaint charging Kent with two counts of Workers’
Compensation Fraud and one count of Theft by Deception-False Impression. According to the complaint,
Kent was injured on July 11, 2011 while working at Blaschak Coal Corporation, and submitted a workers’
Marion Heights,
PA Man Pleads
Guilty to
Workers’ Comp
Fraud & is
Ordered to Serve
23 Months’
Confinement &
Pay $45,654.94
in Restitution
compensation claim to Blaschak’s workers’ compensation insurer, Rockwood Casualty Insurance Company.
Blaschak began receiving bi-weekly payments of $1,329.92. Kent reportedly submitted LIBC-760 forms dated
March, August and September 2013, and January and June 2014 and stated he was not employed while receiving workers’ compensation benefits and that his inability to work remained unchanged. However, the
complaint reflects that on various dates beginning in March 2013 and up to September 2014, Kent was reportedly observed by private investigators and Attorney General special investigators arriving at work at a strip
mine and performing work-related duties and activities. According to the complaint, Kent earned $45,924.56
while working for Fox Coal Company performing mechanical work and operating machinery while collecting
full workers’ compensation disability benefits from Rockwood Insurance Company. [OTN: T5755223]
On August 13, 2015, a Tobyhanna, PA man was granted ARD with six months' probation and was ordered to
pay $1,306 in court costs. In May 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force
had filed a Criminal Complaint in Monroe County charging the defendant with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, the defendant submitted a claim
on February 26, 2016 to Erie Insurance Group claiming that his 2012 Ford Focus had sustained damages on
February 21, 2015 while he was operating the vehicle and slid on ice and hit a guardrail. It was alleged that
the defendant had provided false information as to how the damages were sustained to his vehicle in an effort
to avoid a higher insurance premium resulting from an at-fault accident. Further investigation determined
that the defendant had been involved in an auto accident by rear ending an Allstate insured vehicle in New
Jersey, which was how the damages to his vehicle were incurred. [OTN: T6579613]
On August 14, 2015, a Philadelphia, PA man was granted ARD with two years' probation and was ordered to
pay $1,500 in restitution and court costs of $418.50. On June 17, 2015, after receiving information from the
Philadelphia Police Major Crimes Auto Squad, detectives of the Philadelphia District Attorney’s Insurance
Fraud Unit arrested the defendant and charged him with Insurance Fraud and Forgery. According to the
Criminal Complaint, detectives had obtained the title history for the defendant's Dodge and learned that he
had registered the vehicle with a fraudulent Flagship City Insurance financial responsibility identification
insurance card. Detectives confirmed with Flagship representatives that the policy number listed on the ID
card was not for a valid policy. [OTN: N9676306]
On August 17, 2015, an Allentown, PA woman was granted ARD with nine months’ probation and was ordered to pay $1,788.25 in court costs. Detectives of the Lehigh County District Attorney’s office had filed a
Criminal Complaint in July 2014 charging the defendant with Insurance Fraud and Criminal Attempt Theft
Know the Risks, Know the Penalties
Page11
9
Page
Fraud Stories (Continued)
by Deception-False Impression. According to the complaint, the defendant's son reported a hit-and-run accident to the South Whitehall Police Department on September 9, 2013 involving the defendant’s 2002 Dodge
Durango. Reportedly, when police responded to the scene of the alleged accident, the defendant stated that
her vehicle had been struck and damaged while she was stopped at a stop sign with her adult son and juvenile
daughter as passengers. According to the complaint, all occupants of the Durango at the time of the alleged
incident stated they did not need medical treatment; however, all three later sought medical treatment at
Lehigh Valley Hospital. On September 10, 2013, the defendant notified Nationwide Insurance of the accident
and submitted a claim for damages to the Durango’s grill, bumper, windshield and hood, and later presented a
claim in the amount of $39,919 for medical treatment received by herself and her son and daughter. The complaint reflects that on May 23, 2014, detectives interviewed the prior owner of the Durango, who reportedly
confirmed that the defendant had purchased the Durango from him on August 13, 2013. From photos supplied by the vehicle’s prior owner, the detectives were able to determine that the damage presented to Nationwide already existed when the defendant purchased the vehicle. [OTN: L8768653]
On August 19, 2015, a Brooklyn NY man was granted ARD with 12 months’ probation and was ordered to
pay $1,677.75 in court costs. Detectives of the Lehigh County District Attorney’s office had filed a Criminal
Complaint in March 2015 charging the defendant with Insurance Fraud. According to the complaint, the
defendant applied for auto insurance on July 7, 2014 with the PA Assigned Risk Plan and on application,
listed an Allentown, PA address as his primary address and vehicle garaging location. Reportedly, on August 5,
2014, an analyst reviewing the defendant’s application discovered that the defendant’s listed phone number
contained a New York area code, which subsequently prompted a PA Assigned Risk investigator to verify that
the defendant’s address was actually that of Brooklyn, NY. [OTN: T6312434]
“The complaint states
that the defendant used
her father’s Silver Script
Medicare prescription
card at CVS to obtain
and pay for the
On August 20, 2015, a Trainer, PA woman was granted ARD with 12 months' probation and was ordered to
perform 32 hours of community service and to pay $4,029.60 in restitution and court costs of $1,649. On
controlled substances,
February 6, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division had
filed a Criminal Complaint charging the defendant with 14 counts each of Insurance Fraud and Procure for
and that $3,319.26 in
Self/Other Drug by Fraud, two counts each of Theft by Unlawful Taking-Moveable Property, Theft by Deception-False Impression and Receiving Stolen Property and one count each of Forgery, Criminal Use of Commu-
prescriptions were
nication Facility and Other Reason Access Device is Unauthorized by Issuer. According to the complaint, the
defendant’s father resided with her for a time. During that time, it was alleged that the defendant had contact-
unlawfully obtained...”
ed her doctor to request that prescriptions for Tramadol and Zolpidem Tartrate, both controlled substances, be
written for her elderly father. The complaint states that the defendant used her father’s Silver Script Medicare
prescription card at CVS to obtain and pay for the controlled substances, and that $3,319.26 in prescriptions
were unlawfully obtained by the defendant through her use of her father’s Silver Script Medicare prescription
benefits. [OTN: T4276285]
On August 25, 2015, from Guilty pleas to Acquire or Obtain Possession of Controlled Substance and Conspiracy, Emil A. Sorenson, Jr. was sentenced to serve five years' confinement and was ordered to pay court costs of
$820. Sorenson was arrested in March 2013 by Office of Attorney General special agents. According to the
Criminal Complaint, Sorenson obtained a prescription for Oxycodone, purportedly issued by a physician, for
his girlfriend; however, an investigation revealed that the prescription was fraudulent and that Sorenson and
his girlfriend had allegedly acted as “fillers” for an organization that was illegally trafficking prescription Oxycodone in Northeast Pennsylvania. Victimized insurers listed in the complaint included Horizon Health, Envision Rx Plus, Anthem Blue Cross Blue Shield, Healthtrans, Amerihealth, Pennsylvania Medicaid Prescrip-
Page 12
Know the Risks, Know the Penalties
Fraud Stories (Continued)
tion Drug Program, United Healthcare, Express Scripts, Aetna and Geisinger Health Insurance Companies. [OTN: T3060901]
On August 26, 2015, from a Negotiated Guilty plea to Insurance Fraud, Elizie Falu of Philadelphia, PA was
sentenced to serve 23 months' confinement followed by two years' probation and was ordered to pay a $100
civil penalty and $440.50 in court costs. From a referral received from Allstate Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested Falu in May 2015 and charged him
with two counts each of Insurance Fraud and Theft by Deception. The Criminal Complaint states that Falu
had been involved in an accident on December 26, 2012 while driving a 1997 Dodge truck. Detectives obtained the title history from PennDOT which reportedly showed Falu owned a 1997 Dodge truck and a 2000
Dodge truck. On December 4, 2012, Falu had allegedly registered his 1997 Dodge with an Allstate financial
responsibility identification insurance card and on October 8, 2014, registered the 2000 Dodge with a different Allstate financial responsibility identification insurance card. Detectives contacted Allstate and representatives reportedly confirmed that neither Allstate financial responsibility identification insurance card was valid
nor had Allstate ever insured Falu. [OTN: N9620940]
On August 26, 2015, a Hawley, PA man was granted ARD with six months' probation and was ordered to pay
Confinement
for in Fraudulent Proof of
Insurance Case
court costs of $1,773.50. Detectives of the Northeast PA Insurance Fraud Task Force arrested the defendant
in February 2014 and charged him with two counts of Insurance Fraud. According to the Criminal Complaint, on December 6, 2013, the defendant obtained an auto insurance policy with Safe Auto Insurance
Company to insure his 2000 Pontiac Grand Am GT; and subsequently, on December 8, 2013 at 10:37 PM,
added physical damage coverage to the policy. On December 9, 2013, he initiated a claim with Safe Auto,
reporting that, as he was returning home from picking up his wife at work at around 11:35 PM on December
8, 2013, he’d hit a deer with his Pontiac. On December 10, 2013, the defendant, when questioned by a Safe
Auto claims adjuster, stated that the crash happened on December 8, 2013 at approximately 11:15 PM as he
was returning home from picking up his daughter from work. It was reported that investigators found from
towing records that the defendant's damaged vehicle had been towed on December 8, 2013 at 10:24 PM;
prior to the time that he reportedly had increased his insurance coverage. Safe Auto had reportedly not paid
the defendant’s damage claim. [OTN: T4347976]
On August 28, 2015, a Philadelphia, PA woman was granted ARD with 12 months' probation and was ordered to pay $417.50 in court costs. In June 2014, from a referral received from PMA Insurance Company,
detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested the defendant and charged
her with Insurance Fraud, Theft by Deception-False Impression and Workers’ Compensation Fraud on June
11, 2014. The Criminal Complaint reflects that on November 30, 2004, the defendant allegedly hurt her
back moving a box of hamburgers while working as a food service manager for the School District of Philadelphia and had since been receiving Temporary Total Disability benefits from PMA, the third party workers’
compensation administrator for the School District of Philadelphia. On forms given PMA while receiving
disability benefits, the defendant stated that she was not self-employed nor had she undergone any change in
her condition. PMA investigators, however, found that the defendant had begun working at a dog care facility, and video surveillance footage showed the defendant doing work that she claimed her continuing disability
prevented her from doing, to include walking and cleaning up after dogs and carrying supplies. Detectives
interviewed the owner of the facility who confirmed that she had worked at the facility for two and a half
years. Detectives were able to determine through surveillance footage and interviews that the defendant misrepresented her employment and continuing disability while receiving workers’ compensation disability bene-
Know the Risks, Know the Penalties
Fraud Stories (Continued)
fits, facts which would have caused PMA to stop or reduce her workers’ compensation benefits. [OTN:
N9185831]
On August 28, 2015, from a Negotiated Guilty plea to Criminal Attempt Theft by Deception-False Impression,
Joanna Clari Adams of Lancaster, PA was sentenced to serve two years' probation and ordered to perform 50
hours of community service, pay $300 in fines and court costs totaling $1,564.50. Office of Attorney General
special agents had filed a Criminal Complaint in March 2015 charging Adams with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression. According to the complaint, Permanent General Assurance
Corporation (PGAC) canceled Adams’ auto insurance policy on January 3, 2012 for non-payment of premiums. On January 16, 2012, Adams contacted PGAC to report that she had almost been involved in an accident
and asked a representative that if the accident had actually occurred, would her vehicle have been covered.
When advised that her policy had been canceled, Adams reportedly made a $50 payment to the insurer to have
her policy reinstated, effective January 17, 2012. Adams subsequently contacted PGAC on January 17, 2012
and claimed that her car had just been damaged in a hit-and-run accident. During a February 4, 2012 recorded
interview, Adams reportedly admitted that the accident had actually taken place on the 16th just before she
called PGAC to reinstate her policy. PGAC denied Adams’ claim. [OTN: T6280072]
11
Page 13
Page 14
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*October 19—21, 2015 — NJSIA 25th Anniversary Seminar — Harrah’s Resort, Atlantic City,
NJ http://njsia.memberlodge.org/event-1810564
*April 7—8, 2016 — PA 2015 Insurance Fraud Conference — Hershey Lodge & Convention
Center, Hershey, PA
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Who to Call
Page 15
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]