Pennsylvania Fraud Stories - Pennsylvania Insurance Fraud

Transcription

Pennsylvania Fraud Stories
JANUARY 2015
Pennsylvania Insurance Fraud
Prevention Authority
Message from the Executive Director
Inside this issue:
W
elcome to the January 2015 edition of our monthly newsletter,
reporting December’s arrests and dispositions. 2014 was another
Public Relations
2
Know the Risks!
3
Prescription Fraud
3
percent over 2013, but a five-year increase of 9 percent. In 2014, 447 ar-
Bogus Auto Theft
4
rests of those engaging in insurance fraud crimes were made by IFPA
Scripts for Profit
5
Philadelphia DA Arrests
6
successful year for fraud fighters in the Commonwealth of Pennsylvania.
A total of 3,162 complaints of suspected insurance fraud (fraud referrals)
were received by IFPA grantees, a decrease in overall fraud referrals of 11
grantees, which is a 10 percent increase in arrests from 2013. Of the 378
Another Alleged
criminal prosecutions concluded in 2014 by IFPA grantees, 114 defendants were diverted to rehabilitation programs and 207 criminal convictions
were obtained; with 48 defendants sentenced to imprisonment. Prosecu-
Ralph Burnham
Thomas Donahue
IFPA
Executive
Director
Executive
Director
“Gaber” Case Partici-
tions saw defendants being ordered to pay a total of $4,539,107 in restitution to insurance fraud
pant
victims and $188,840 in civil penalties to the Fund. A total of $444,174 in court costs and fines
Bogus Proof of Insur-
7
ance
Media, PA Doctor
The Commonwealth’s insurance fraud problem, as seen in 2014 through the eyes of the IFPA’s law
8
Charged with Insur-
volved auto insurance, 10 percent homeowners’ insurance, 6 percent commercial property/liability,
9
12 percent workers’ compensation insurance, 5 percent life insurance and 11 percent health insurance. And in arrests, it was seen that 63 percent of arrests came from cases involving auto insurance
Fraud
Know the Penalties!
enforcement grantees, impacted all lines of insurance; and, in sheer numbers of fraud, those types of
insurance written by property and casualty insurance companies. In fraud referrals, 51 percent in-
ance Fraud
$25,124.60 Loss a
were also ordered paid by defendants to the courts.
10
fraud, 16 percent homeowners’ insurance, 4 percent commercial property/liability, 3 percent workers’ compensation insurance, 1 percent life insurance and 13 percent health insurance.
Mark Your Calendar!
17
Thank you to everyone who assisted in making 2014 another successful year. I look forward to a
successful 2015.
Who to Call
18
The Pennsylvania Fraud Conference will be held in Hershey, PA on Monday, April 27 th and Tuesday, April 28th. Our group of presenters make for another outstanding conference. Registration emails will be going out shortly.
Finally, our “Don’t Be a But” campaign will be a sponsor of “Motorama” held at the Pennsylvania
Farm Show Complex and Expo Center in Harrisburg, PA on Saturday, February 21 st and Sunday
February 22nd. We will have a display booth on site with our mascot, Weasy. We hope you’ll come
out and join us!
Thanks again for all that you do in combating 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.
The Pennsylvania Office of Attorney General’s (OAG) Insurance Fraud Section reported 21 insurance
fraud arrests in December 2014. We’ve included some of the OAG’s arrest summaries in this newsletter;
however, a complete account of the OAG’s December arrests can be found by clicking on the following
link to be directed to the Insurance Fraud Section’s newsletter. https://www.attorneygeneral.gov/
Criminal/Insurance_Fraud_Section/Insurance_Fraud_Monthly_Newsletter/
On December 17, 2014, Office of Attorney General (OAG) special agents arrested 29 year-old Laura A. Williams of Greensburg, PA and charged her with Insurance Fraud and Pharmacy Act Violation. According to
the Criminal Complaint, Williams was employed as a Rite Aid pharmacist from June 2013 through March
Office of
Attorney
General
Special
Agents Arrest
Rite Aid
Pharmacist
2014. During that time period, it is alleged that Williams 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 December 17, 2014, OAG special agents arrested 49 year-old Joseph Donald Leckemby of Uniontown,
PA and charged him with Insurance Fraud, Acquire or Obtain Possession of Controlled Substances and three
counts of Forgery. According to the Criminal Complaint, between March 2013 and December 2013,
Leckemby presented four unauthorized prescriptions for Oxycodone at local pharmacies. Leckemby allegedly
altered otherwise legitimate prescriptions to make it appear that the scripts were written for Oxycodone.
Leckemby allegedly used his United Healthcare Insurance to pay for two of the prescriptions. [OTN:
T6008015]
On December 17, 2014, OAG special agents arrested 25 year-old Ashley B. Hamilton of Croydon, PA and
charged her with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression. According to
the Criminal Complaint, Hamilton staged a slip-and-fall accident inside of a Walmart, who is self-insured, on
October 2, 2012. On November 9, 2012, Hamilton allegedly provided a recorded statement to Walmart,
indicating that she had been walking in the store’s shampoo aisle when she slipped on a liquid and fell to the
floor. Investigators reviewed store surveillance footage, which allegedly showed Hamilton walking down an
aisle at Walmart, stopping in the middle of the aisle, then sitting on the floor and lying down on her back.
[OTN: T6007794]
On December 17, 2014, OAG special agents arrested 35 year-old Wakia Bracy of Darby, PA and charged her
with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression. According to the Criminal
Complaint, Bracy purchased a liability only automobile policy from Allstate Insurance Company on July 25,
2012. On February 15, 2013, Bracy contacted Allstate at 2:47 PM to add collision, comprehensive, rental and
roadside assistance coverage to her policy. Bracy contacted Allstate again at 5:20 PM on the 15 th 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 Bracy added the coverage to her policy. [OTN: T6007551]
Page 4
Fraud Stories (Continued)
On December 17, 2014, OAG special agents arrested 43 year-old Scott Allen Hovis of Franklin, PA and
charged him with Insurance Fraud, Theft by Deception-False Impression, Criminal Attempt Theft by Deception and Tamper Records or ID Writing. According to the Criminal Complaint, between April 2012, and
March 2013, Hovis filed claims on his Aflac Insurance accident policy. The policy went into effect on March
26, 2012. In his claims, Hovis allegedly stated that he fractured his hip and injured his elbow while lifting
furniture on April 1, 2012, that he injured his head, pelvis and leg when he fell from a roof on June 9, 2012,
and that he injured his shoulder, hip, and elbow on March 19, 2013. In support of these claims, Hovis allegedly submitted documentation which was purportedly prepared by medical provider UPMC Northwest. Investigators allegedly determined that although Hovis had been treated by UPMC on April 1, 2012, he had no broken bones. According to the Criminal Complaint, Hovis was not treated on June 9, 2012, or on March 19,
2013. The criminal complaint stated that Hovis altered the paperwork to embellish his April 1, 2012 injuries,
and that he fabricated the injuries he claimed had occurred on June 9, 2012, and on March 19, 2013. Hovis
allegedly received $3,395 from Aflac for his first two claims. Aflac denied payment of the third claim. [OTN:
T6008844]
On December 17, 2014, OAG special agents arrested 43 year-old Whitney Hooks of Folsom, PA and charged
her with Insurance Fraud, Theft by Deception-False Impression and False Reports. According to the Criminal
Complaint, Hooks and her sister lived together and were identified as named insureds on an Allstate Insur-
“...Allstate retained two
ance Company policy which covered a vehicle owned by Hooks’ sister. It is further alleged that the policy
listed a niece as a member of the sisters’ household and as a driver of the insured vehicle. In February, 2012,
experts who examined the
Hooks allegedly reported to local police and to Allstate that she discovered that her sister’s car had been stolen
from a parking lot in Glenolden, Delaware County. According to the complaint, Allstate interviewed Hooks
vehicle and concluded that
about the circumstances of the theft and obtained her cellular phone records. During the interview, Hooks
again allegedly told Allstate that she had been the last person to drive her sister’s vehicle before it was stolen.
The vehicle was recovered nine days after the reported theft with approximately $8400 damages to the vehicle’s exterior. The complaint further stated that Allstate retained two experts who examined the vehicle and
concluded that the car had been driven with a factory key and therefore had not been stolen. According to the
complaint, the investigators also determined that Hooks’ niece was the last person to have driven the car prior
to its purported theft. [OTN: T6003141]
On December 17, 2014, OAG special agents arrested 32 year-old Thomas A. Apitsch of Pittsburgh, PA and
charged him with two counts of Insurance Fraud and one count of Theft by Deception-False Impression. According to the Criminal Complaint, Apitsch applied for an auto policy through The General Insurance Company on May 27, 2014. In his application, Apitsch allegedly stated that he had not been involved in any accidents during the prior 35 months. On May 30, 2014, Apitsch filed a claim with The General, in which he
allegedly stated that on May 28, 2014, Apitsch struck a neighbor’s motorcycle while backing his car out of the
driveway. According to the complaint, the motorcycle sustained $3372.48 in damages. However, an investigation allegedly revealed that the accident actually occurred on May 24, 2014, before Apitsch obtained a policy
with The General. [OTN: G6983244]
On December 17, 2014, OAG special agents arrested 41 year-old Staci Gaffney of Jeannette, PA and charged
her with Insurance Fraud and Criminal Attempt Theft by Deception. According to the Criminal Complaint,
on July 25, 2013, Gaffney obtained a policy from Aflac Insurance Company whereby she would receive coverage for medical treatments stemming from an accident. On July 12, 2013, Gaffney allegedly submitted to Aflac
a claim pertaining to injuries she purportedly suffered during a fall. Gaffney also allegedly submitted reports
and letters from medical providers which purportedly verified treatment she received for her injured knee after
the car had been driven with
a factory key and therefore
had not been stolen.”
Page 5
June 26, 2013. According to the complaint, investigators determined that Gaffney had altered certain dates
on the provider documents she submitted to the insurer, and that she had actually injured her knee in
March, 2013, before she obtained her Aflac policy. {OTN: T6007072]
On December 2, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed a Criminal Complaint charging 28 year-old Jasvir Kaur of Upper Darby, PA with Insurance Fraud,
Criminal Use of Communication Facility and two counts of Criminal Attempt-Theft by Deception. According to the complaint, Kaur reported that her 2012 Nissan Sentra was struck by an unknown vehicle in a
shopping center parking lot. Kaur stated that she left her parked car in the parking lot at approximately 9:00
AM, when she met up with a friend and the two left in her friend’s vehicle. When she returned at approximately 5:00 PM, she stated she noticed heavy front end damage to the Nissan. On September 2, 2014, Kaur
in a recorded interview with detectives had admitted to fabricating the reported hit-and-run and that she’d
actually been involved in an accident that morning when she rear-ended another vehicle. No accident report
Upper Darby, PA
Woman
Reportedly
Rear-Ends
Another
Vehicle; Alleges
to Her Insurer
Her Unattended
Vehicle Was
Involved in a Hit
-and-Run
was made as the vehicle Kaur struck had sustained minimal damage and the driver reportedly felt it was unnecessary to report the accident. According to the complaint, Kaur stated she believed the damages to her
vehicle would not be covered under her auto insurance policy of CSAA Insurance Group and therefore
opted to make a false claim about a hit-and-run. The estimated cost to repair the Nissan’s damages was
$4,101.83; however, CSAA had not paid Kaur’s claim. [OTN: T5946662]
On December 3, 2014, insurance fraud detectives in Philadelphia arrested 21 year-old Romiah S. Coleman
of Philadelphia, PA and charged her with Insurance Fraud, Forgery and Unsworn Falsification after receiving a referral from a sergeant at the Philadelphia Police Impound Lot. According to the Criminal Complaint, on March 12, 2014, Coleman attempted to retrieve her 2004 Chevrolet from impound and presented
a Bristol West Insurance Company financial responsibility identification card. Detectives contacted Bristol
West and a representative confirmed that they do not insure Coleman nor is the listed policy number of the
identification card valid. Further, detectives retrieved the title history for the vehicle and learned that Coleman had allegedly registered the vehicle with a fraudulent State Farm Insurance financial responsibility
identification card, and that Coleman was never insured by State Farm. [OTN: N9428672]
On December 4, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed a Criminal Complaint charging 53 year-old Carmelo Perez Morales of Folcroft, PA with Insurance
Fraud, Manufacture, Delivery or Possession with Intent to Deliver, Possession of Controlled Substance and
Use/Possession of Drug Paraphernalia. The complaint reflects that Morales allegedly utilized his Medicare
Health Insurance card to purchase Percocet and Oxycodone, both controlled substances, and would then
sell them on the street for a profit. According to the complaint, Morales had given an undercover detective
118 Percocet pills in exchange for $2,000. [OTN: L9078580]
On December 9, 2014, detectives of the Allegheny County Police Department filed a Criminal Complaint
charging 45 year-old Raynell L. Jones of Pittsburgh, PA with Insurance Fraud. According to the complaint,
Jones' auto insurance policy through GEICO Insurance had been reissued on September 24, 2014 at 5:39
PM. Jones later contacted GEICO on September 24, 2014 to report that she had been involved in an accident on the 24th at 6:40 PM. The complaint reflects that a Greentree Police Crash Report listed the dispatch time to the accident scene at 5:33 AM and the arrival time as 5:39 PM. Jones later admitted that she
had contacted GEICO from the scene of the accident to reinstate her auto policy and did not disclose at that
time that she had just been involved in an accident. [OTN: G6978823]
Page 6
On December 9, 2014, from a referral received from Safe Auto Insurance Company, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint charging 28 year-old Elizabeth
Anne Stoko of Baltimore, MD with Insurance Fraud. According to the complaint, Stoko’s auto insurance
policy with Safe Auto Insurance was canceled on March 15, 2014. Stoko reportedly had not obtained a new
auto insurance policy until April 18, 2014 at 10:45 AM and, in applying for the new policy, provided a Dalton, PA address as the primary garaging location of her vehicle. On July 10, 2014, Stoko initiated a claim with
Safe Auto stating that she had been involved in a two-vehicle accident on April 18, 2014 at 7:00 PM when she
backed into another vehicle. However, according to the owner of the other vehicle, the accident had occurred
on March 17, 2014; two days after Stoko’s policy had been canceled. Further investigation revealed that the
accident occurred during the time Stoko was uninsured, and that Stoko’s primary address was that of Baltimore, MD, not Dalton, PA. Safe Auto denied the claim. The owner of the vehicle Stoko backed into has not
been reimbursed for the damages to her vehicle estimated at $1,810.04. [OTN: T5976751]
charging 57 year-old Patrick Kellner of Pittsburgh, PA with Insurance Fraud. According to the complaint,
Kellner reported to Homesite Insurance Company that his bicycle was stolen. In support of his claim,
Kellner emailed a computer generated customer receipt, allegedly from Pro Bikes Monroeville, in the amount
of $1,371.74; however, detectives reportedly learned from Pro Bikes Monroeville that the actual receipt for
“The complaint reflects
the bicycle was in the amount of $1,029.61 and that the receipt Kellner submitted had been altered. According to the complaint, Kellner's deductible on his renter's policy was $500. Homesite had not paid Kellner's
Dukes had supplied an
claim. [OTN: G6978790]
charging 54 year-old Frederick Boehm of Pittsburgh, PA with Insurance Fraud. The complaint reflects that
Boehm had reported to his insurer, GEICO Insurance Company that upon returning from a weekend away
on August 11, 2014, he’d discovered his 2005 Chevrolet Uplander had been keyed. Investigators learned
through the investigation that Boehm had made a similar claim to Farmers Insurance Company in November
2013, and Farmers had paid Boehm $4,037 on his vandalism claim. According to the complaint, investigators
found through photographs of the Uplander that the damages were similar and alleged that they were preexisting from Boehm’s November 2013 claim. [OTN: G6978801]
On December 9, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division
filed a Criminal Complaint charging 30 year-old Jason Dukes of Glenolden, PA with three counts each of
Insurance Fraud, Manufacture, Deliver, or Possession with Intent to Manufacture or Deliver and Possession
of Controlled Substance. According to the complaint, it was alleged that Dukes had utilized his Medicare
Part D prescription plan to procure controlled substances and would then distribute them on the street for a
profit. The complaint reflects that on one occasion, Dukes had supplied an undercover detective with two
Suboxone and two Alprazolam pills in exchange for $30, and on another occasion had provided the detective
with two Suboxone pills in exchange for $20. [OTN: T5975620]
On December 11, 2014, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 57
year-old Karen Kokason of Philadelphia, PA and charged her with Insurance Fraud, Theft by Deception, Perjury, False Swearing and False Reports. According to the Criminal Complaint, Kokason was investigated for a
fraudulent slip-and-fall case related to an investigation involving the law office of Andrew H. Gaber, an attorney who was alleged to have directed a complex insurance fraud scheme that defrauded 21 insurers of nearly
$400,000 through claims made by motor vehicle, commercial liability and homeowners insurance policies
that on one occasion,
undercover detective with
two Suboxone and two
Alprazolam pills in
exchanged for $30....”
Page 7
from staged slip-and-fall accidents. Kokason had retained Gaber to represent her in a personal injury claim
against Chubb Insurance Company. Kokason, on August 28, 2013, had testified that she had tripped over
uneven cement which caused her to injure her knee and back. In support of Kokason’s claim, Kokason was
taken to the hospital on the date of the alleged incident and later sought further medical treatment. Detectives
obtained witness statements that contradicted Kokason’s account of the fall and it was alleged that her claim
was fraudulent. [OTN: N9434611]
From a referral received from Progressive Insurance Company, detectives of the Allegheny County District
Attorney’s Office filed a Criminal Complaint on December 12, 2014 charging 34 year-old Twanda Mae Harrell of McKeesport, PA with two counts of Insurance Fraud. According to the complaint, Harrell purchased a
full coverage auto insurance policy from Progressive on October 6, 2014 at 12:21 PM and later that same day,
reported to Progressive that on October 6, 2014 at 2:26 PM, her 2004 Lincoln Navigator drifted forward and
hit a utility pole, causing damage to the front end. However, according to the complaint, investigators learned
the damages to the Navigator were obtained from an accident that had actually taken place on October 2,
“Damages to Taylor’s
vehicle were estimated to be
2014 at 11:40 PM, prior to Harrell having full coverage insurance on the vehicle. Progressive had not paid
Harrell’s claim. [OTN: G6945971]
$5,016.44, and $3,200 to
On December 16, 2014, insurance fraud detectives of the Lehigh County District Attorney’s office filed a
Criminal Complaint charging 30 year-old Kyle Paul Klausz of Phillipsburg, NJ with Insurance Fraud. The
the victims’ vehicles. State
complaint reflects that Klausz had applied for an Esurance Insurance auto insurance policy and provided an
Easton, PA address as his primary residence and garaging location of his 2013 Dodge Dart; however, it was
Farm had paid a total of
$8,216.44 in damage
repairs to all vehicles
involved.”
alleged that Klausz had moved from the Easton, PA address two years ago and was now a resident of Phillipsburg, NJ. [OTN: T6730360]
Criminal Complaint charging 37 year-old Jennifer Ann Taylor of Emmaus, PA with Insurance Fraud, Theft by
Deception-False Impression and Accidents Involving Damage to Unattended Vehicle or Property. According
to the complaint, on November 9, 2014 at 1:42 AM, police officers responded to a hit-and-run accident involving a red sedan which had struck two parked cars causing damage. Taylor reportedly, on November 10, 2014
at 9:51 AM filed a claim with State Farm Insurance Company stating that her red 2013 Chevrolet Cruze
sedan had been struck while parked at a friend’s house. On November 11, 2014, officers located the defendant’s vehicle at Scott Collision Center in Allentown with damage that was consistent with having been involved in the hit-and-run reported on November 9, 2014, and according to the complaint, on December 4,
2014 the defendant admitted that she’d been involved in the hit-and-run on the 9th. Damages to Taylor’s vehicle were estimated to be $5,016.44, and $3,200 to the victims’ vehicles. State Farm had paid a total of
$8,216.44 in damage repairs to all vehicles involved. [OTN: L9103091]
On December 16, 2014, from a referral received from Erie Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 24 year-old Eric Taylor of Philadelphia, PA and charged
him with Insurance Fraud and Forgery. According to the Criminal Complaint, on August 31, 2013, Taylor’s
2004 Chevrolet was involved in an accident while not being properly insured. Detectives obtained the title
history for the vehicle which stated that the card had been registered with a State Farm Insurance Company
financial responsibility identification card, and when detectives contacted State Farm to verify that Taylor’s
policy was valid, State Farm’s representative advised detectives that the listed policy number was not for a valid
policy and that the company did not insure Taylor. [OTN: N9444702]
Page 8
Criminal Complaint charging 18 year-old Emily Sowers of Emmaus, PA with Insurance Fraud and False Reports. According to the complaint, on November 16, 2014, an employee of a Turkey Hill in Emmaus, PA
reported that a vehicle had been driven into the front of the building causing damage. Police officers responded to the incident, and the defendant reported that she had been driving the 2007 Chevrolet Cobalt
when it crashed into the front of the store, and subsequently filed a claim with Allstate Insurance Company
reporting the same. However, upon viewing video surveillance footage of the accident, it was revealed that the
defendant had actually switched seats with another individual who was unlicensed and driving the vehicle at
the time of the accident. [OTN: L9105633]
On December 17, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division charged 60 year-old Dr. Lawrence P. Wean of Media, PA with three counts of Insurance Fraud and 14
counts of Administration of Controlled Substances by Practice. According to the Criminal Complaint, on
several occasions between July 2014 and October 2014, two undercover detectives had posed as patients of
Dr. Wean by presenting false identities to Dr. Wean’s office. No medical histories or medical documentation
was documented during either detectives’ visits, nor were any physical examinations or tests performed by Dr.
Wean or his office; however, Dr. Wean had allegedly prescribed various controlled substances to include
Oxycodone, Adderall, Xanax, Restoril, Vicodin and Percocet simply by the request of the undercover detectives who had posed as patients. According to the complaint, it was further alleged that Dr. Wean had also
submitted fraudulent claims to Independence Blue Cross for services that were not performed. [OTN:
L9105471]
From a referral received from Highmark Insurance Special Investigation’s Manager, the Cumberland County
District Attorney’s Criminal Investigation Division filed a Criminal Complaint on December 18, 2014 charging 35 year-old Roman Ildefonso-Candelario of New Oxford, PA with two counts of Insurance Fraud and
one count each of Theft by Deception-Fail to Correct and Identity Theft. According to the complaint, a complaint was made in September 2014 by Osvaldo Martell Diaz, a resident of New York, who believed his identity had been stolen and was being used by another, subsequently identified as Candelario. According to the
complaint, Diaz was a patient at Lincoln Hospital in New York and attempted to arrange for a medical procedure, and while registering at the hospital Diaz was reportedly told that he would be unable to utilize his New
York State-funded Medical Assistance as he had additional insurance through Highmark Blue Shield in Pennsylvania. The investigation revealed that the name, date of birth and social security number given by Diaz in
New York was the same that Candelario provided and further that Candelario had numerous dates of service
from various providers that resulted in Highmark Blue Cross Blue Shield paying some $23,499.91 in medical bills of Candelario. [OTN: T6016662]
year-old Laquanda Marshall of Philadelphia, PA and charged her with Insurance Fraud and Forgery. According to the Criminal Complaint, detectives had received information that Marshall’s 2000 Buick was uninsured. Detectives obtained the title history for the Buick and learned that Marshall had registered the vehicle
in April 2013 with an American Independent Insurance Company financial responsibility identification
card, and then in March 2014 with a 21st Century Insurance financial responsibility identification card.
Detectives reportedly contacted both companies, who confirmed that both cards were fraudulent. [OTN:
N9447561]
Delaware
County Doctor
Alleged to Have
Provided
Controlled
Substances to
Detectives Who
Posed as
Patients;
Submitted
Fraudulent
Claims for
Services Not
Rendered
Page 9
On December 19, 2014, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed a Criminal Complaint charging 42 year-old Michael Cappa of Havertown, PA with Forgery, Insurance Fraud, Tamper Records or ID Writing, Tampering with Physical Evidence and Unsworn Falsification to
Authorities. According to the complaint, it had been alleged that Cappa removed his estranged wife who had
filed for divorce from his Mercy Health System health insurance policy by providing a “Life Change Event”
form and a fraudulent divorce decree which contained several inconsistencies and was reportedly forged with
a judge’s name that does not exist. In doing so, Cappa had paid a total of $23.09 in biweekly premiums for
medical and dental coverage for his estranged wife. [OTN: T6021260]
On December 19, 2014, detectives of the York County District Attorney’s Office filed a Criminal Complaint
charging 83 year-old Paul C. Noel of York, PA with Insurance Fraud. According to the complaint, it was
alleged that in applying for an auto insurance policy with Donegal Insurance Group, Noel had failed to
disclose that his granddaughter was the primary driver of the Volkswagen Jetta listed on the policy and further, that she resided at his residence and did not have a valid driver’s license. [OTN: T6021164]
“Williamson admitted to
having the vehicle stolen and
damaged for the purpose of
On December 19, 2014, the Allegheny County District Attorney’s Office received a case for prosecution
regarding 21 year-old Joshua M. Williamson and 23 year-old Alexander E. Shissler, both of West Mifflin, PA.
Detectives of the West Mifflin Police Department had arrested the defendants on November 24 and 25,
2014 respectively, charging each with Insurance Fraud, Criminal Mischief-Tamper with Property, False Re-
collecting the insurance
ports and two counts of Conspiracy. According to the Criminal Complaints, Williamson reported the theft
of his 2013 Hyundai Genesis on August 25, 2014 at 6:18 AM to the West Mifflin Police Department. Subse-
money...Erie had paid
quently, the vehicle was recovered at 6:57 AM and was towed from the scene to the police department’s impound, where detectives reportedly found the entire vehicle had sustained severe damage to include black
Williamson $1,522.60 in
spray paint on the passenger door, smashed windows and lights, white paint throughout the interior and
under hood area in addition to white sugar dumped throughout the interior and a funnel filled with sugar
towing, storage and rental
fees.”
inside the gas tank line. Detectives retrieved various items to submit into evidence, and in a subsequent interview with Williamson reportedly denied that he had purchased the items used to damage his vehicle; however, according to the complaint, on September 24, 2014, detectives reportedly spoke to a fraud investigator of
Erie Insurance Company who stated that he had spoken to Williamson and during their conversation, Williamson stated he had purchased the paint, axe, sugar and other items and that these items were in the back
seat of the vehicle when it was stolen. Upon receiving this information, detectives again interviewed Williamson. At that time Williamson admitted to wanting to dispose of the vehicle as he owed more on it than its
value and that Shissler offered to help him dispose of the vehicle. He stated that he’d left the key fob to the
Genesis and that Shissler and another acquaintance told him they’d “take care of it”. Williamson admitted to
having the vehicle stolen and damaged for the purpose of collecting the insurance money. Erie’s adjuster had
deemed the vehicle a total loss at a value of $25,124.60. Erie had paid Williamson $1,522.60 in towing, storage and rental fees. [OTN: G6914272, G6914283]
year-old Victor Harry of Philadelphia, PA and charged him with Insurance Fraud, Theft by Deception, Conspiracy and False Reports. According to the Criminal Complaint, the defendant was charged previously in
connection with an investigation involving American Collision, a South Philadelphia body shop. The complaint reflects that on July 31, 2011, Harry was involved in a staged accident. A Philadelphia Police report
stated that there were no reported injuries resulting from the accident nor was a tow truck needed; however,
Allstate Insurance Company had later paid Harry over $20,000 to settle his claim. According to the com-
Page10
9
Page
plaint, witnesses connected to the investigation confirmed that the accident was fraudulent and had been
staged by Harry and the manager of American Collision. [OTN: N9452111]
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
Shariff 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. [OTN: N9458595, N9458540]
“A Philadelphia Police
report stated that there
were no reported injuries
resulting from the accident
nor was a tow truck
The Penalties:
The following dispositions of cases previously reported on were obtained via the web
portal of Pennsylvania’s Unified Judicial System.
needed; however, Allstate
Insurance Company had
later paid Harry over
On December 3, 2014, Ruschelle Lee Henry of Shippensburg, PA pled Guilty to Insurance Fraud and was
sentenced to serve 18 months' probation and was ordered to pay $150 in fines and $817.50 in court costs. On
October 30, 2014, Office of Attorney General special agents arrested Henry and charged her with Insurance
Fraud and Criminal Attempt-Theft by Deception. According to the Criminal Complaint, Henry filed a claim
with Select Insurance Company on November 20, 2013. She allegedly told Select that her vehicle was involved
in an accident at 11:30 a.m. on November 20th, when her car struck a piece of equipment owned by the local
borough. According to the complaint, Henry’s vehicle incurred more than $6400 in damages due to the accident. The complaint further stated that Henry’s policy was cancelled for non-payment on November 14, 2013,
several days before the accident occurred. According to the complaint, Henry contacted Select to reinstate her
coverage on November 19, 2013, at 8:23 p.m. She allegedly told the insurer that her vehicle had not been damaged or involved in an accident after the policy was cancelled. According to the complaint, investigators ultimately determined that Henry’s vehicle accident occurred on November 19, 2013, at 11:30 a.m., before Henry’s coverage was reinstated. [OTN: T5666791]
On December 3, 2014, from Negotiated Guilty pleas to Insurance Fraud, Corrupt Organizations, Conspiracy
and Theft by Deception-False Impression, Arthur Juliano of Philadelphia, PA was sentenced to serve five years'
probation and was ordered to pay $5,000 in civil penalties to the Insurance Fraud Prevention Trust Fund and
court costs totaling $736. The Criminal Complaint reflects that Juliano was a participant in a multi-million
dollar scheme involving Ronald Galati, Sr. and 39 others to defraud insurance companies and Philadelphia
taxpayers. Charges resulted from a 16-month grand jury investigation of American Collision and Auto Center
in Philadelphia. Defendants included a Philadelphia police officer, a city official, insurance company adjusters
$20,000 to settle his
claim.”
Page 11
and two truck drivers who engaged in the scheme to defraud insurance companies and Philadelphia taxpayers.
The investigation revealed that the Galati family used American Collision and Car One Rental as corrupt organizations to file fraudulent insurance claims for financial gain. Over the past four years, victim insurance
companies reportedly issued payments totaling over $2,311,288 in connection to fraudulent claims submitted
from American Collision. American Collision established a pattern of filing fraudulent claims with insurance
companies due to fictitious deer accidents, vandalism, vehicular damages due to falling objects, enhanced damages that compensated for waived deductibles and the use of luxury cars in staged collisions in order to generate large settlement checks. Galati reportedly stored deer blood, hair and carcasses in the back of his shop, as
well as weeds collected from river banks by shop employees to serve as props for deceptive pictures of alleged
vehicular damages as part of insurance claims. The investigation revealed that Galati had coached customers on
Defendant
Involved in
Multi-Million
Dollar Scheme
Ordered to
Serve
Probation &
Pay $5,000 to
Insurance
Fraud
Prevention
Trust Fund
how to report incidents to their insurers in order for the insurers to assume responsibility without imposing
rate increases, and also supplied local tow truck drivers with a list of vehicles owned by previous customers and
would allegedly instruct the drivers to damage these cars in order to create and secure business for his shop.
[OTN: N9171982]
On December 4, 2014, Belinda K. Teets of Smithfield, PA pled Guilty to Theft by Failure to Make Required
Disposition of Funds and was sentenced to serve three years' probation and ordered to pay $17,369.90 in restitution, $400 in fines and court costs totaling $2,979.50. On May 23, 2014, from a referral received of the PA
Department of Insurance from their investigation of a complaint made by American National Insurance Company, Office of Attorney General special agents filed a Criminal Complaint charging Teets with Theft by Failure to Make Required Disposition of Funds, Theft by Deception-False Impression and Misapplication of Entrusted Government/Financial Institution Property. According to the complaint, Teets was employed at the
James Lucidi Insurance Agency from April 11, 2011 through early 2013 and was responsible for accepting
premium payments from the agency’s clients for paying of clients’ American National policies. The complaint
reflects that in early 2013, approximately 30 policy holders were notified by American National that their policies were to be canceled for non-payment of premiums. The clients were able to show investigators that they’d
paid their premiums to Teets by cash or check, and in many cases had receipts that had signed by Teets. It was
alleged that Teets accepted premium payments from clients totaling $17,369, not processing them for payment
to American National and stealing the funds. [OTN: T4658964]
On December 5, 2014, a Philadelphia, PA man was granted ARD with two years' probation and was ordered to
pay $2,000 in restitution and court costs of $1,017.50. Detectives of the Philadelphia District Attorney’s Insurance Fraud Unit, after receiving a referral from officers of the Philadelphia Police Major Crimes Auto Squad,
had charged the defendant with Insurance Fraud, Theft by Unlawful Taking, Criminal Conspiracy and False
Reports on April 8, 2014. According to the Criminal Complaint, it had been alleged that the defendant had
made a false claim to his insurer, Nationwide Insurance Company, by stating that his 2007 Buick Lucerne had
been stolen on August 9, 2012. However, as officers were reviewing a list of vehicles that had been dropped off
at Clearfield Recycling, they reportedly came across the defendant’s Buick and learned from the recycling facility that the defendant had actually sold the vehicle to the facility on August 8, 2012. Nationwide representatives
provided detectives information that the defendant had received a theft claim settlement in excess of $16,000.
[OTN: N9088796]
On December 8, 2014, from a Negotiated Guilty plea to Conspiracy and Manufacture, Delivery or Possession
with Intent to Manufacture of Deliver, Amelia C. Moffitt of Clifton Heights, PA was sentenced to serve a maximum of four years' confinement followed by two years' probation and was ordered to pay $1,000 in fines, $800
in restitution and court costs totaling $1,617. Detectives of the Delaware County District Attorney’s Criminal
Page 12
Investigation Division had filed two Criminal Complaints in September 2014 charging Moffitt with two
counts each of Insurance Fraud, Conspiracy and Manufacture, Delivery or Possession with Intent to Manufacture of Deliver, three counts of Theft by Deception-False Impression and four counts of Criminal Use of
Communication Facility. Also charged was James Andrew Knox, also of Clifton Heights, PA, with two counts
each of Insurance Fraud, Conspiracy, Theft by Deception-False Impression and Manufacture, Delivery or
Possession with Intent to Manufacture or Deliver. According to the complaints, Moffit would obtain prescriptions for Oxycodone and Percocet and purchase the scripts using her Keystone Mercy Health Insurance
prescription card. She and Knox would then sell the scripts for a profit. According to the complaint, Moffit
and Knox had, on several occasions, sold the prescription drugs to an undercover detective. The complaints
reflect that Moffit had been driven by the undercover detective on August 22, 2014 to a Walgreen’s Pharmacy to have a prescription for Oxycodone filled, 75 of which were to be sold to the undercover detective. Moffit was arrested after obtaining the script and exiting the pharmacy. Court records reflect that Knox is to be
sentenced in January 2015. [OTN: T5621781, T5621582]
On December 9, 2015, Corey Andrew McGahen of Union City, PA pled Guilty to Criminal Attempt Theft
by Deception and was sentenced to 12 months in the Intermediate Punishment Program and was ordered to
pay $100 in fines and court costs totaling $365. Office of Attorney General special agents had filed three
Criminal Complaints on March 17, 2014 charging McGahen and two co-defendants, Michelle Marie Sterling
and William G. Stinebiser, both of Union City, PA with two counts of Insurance Fraud and Attempted Theft
by Deception. According to the complaints, on July 4, 2013 at 10:20 AM, Sterling contacted her auto insurer,
GEICO Insurance, to add collision coverage to her auto insurance policy. On July 7, 2013 at approximately
10:02 AM, Sterling filed a claim with GEICO alleging that she and a passenger, William Stinebiser, Jr., were
involved in a roll-over crash that occurred that morning at approximately 2:00 AM; and stated that following
the accident she had contacted a friend, Corey McGahen, who worked for Leroy’s Towing to have the vehicle
towed. The three defendants, in recorded statements given GEICO, were alleged to have misrepresented the
date of the accident to GEICO, so as to make it appear that the accident occurred after Sterling added collision coverage to her GEICO policy. A tow receipt reportedly showed that the vehicle had been towed on July
4, 2013 between 1:30 PM and 2:00 PM, and according to the complaint, Sterling and McGahen admitted
that they had agreed to provide false statements to GEICO to have damages to Sterling’s car paid for by GEICO. GEICO’s adjuster appraised the vehicle’s damages at $557.14; however, GEICO had not paid the claim.
Court records reflect that the cases against Sterling and Stinebiser remain active. [OTN: T4471493,
T4471482, T4471633]
On December 10, 2014, from a Negotiated Guilty plea to Insurance Fraud and Operating a Vehicle without
Required Financial Responsibility, Kena Powe of McKees Rocks, PA was sentenced to serve 12 months’ probation and ordered to pay court costs of 562.80. On November 22, 2013, detectives of Allegheny County
Police Department arrested Powe and charged her with Insurance Fraud and Failure to Maintain Required
Financial Responsibility. According to the Criminal Complaint, Powe was involved in an automobile accident on October 11, 2013 while operating her 2008 Hyundai without valid auto insurance. Reportedly, Powe’s auto insurance with Progressive Insurance had been canceled on August 30, 2013 for her non-payment of
premiums. Allegedly, Powe renewed her Progressive auto insurance policy on October 11, 2013, after her
accident, and then filed a claim with Progressive on October 13, 2013 misrepresenting that her accident took
place on October 12, 2013. The case was prosecuted by the Allegheny County District Attorney’s Office.
[OTN: G6621075]
Clifton Heights
Woman
Sentenced to
Prison
Page 13
On December 11, 2014, from a Guilty plea to Insurance Fraud, Robert Monaco of Wilkes-Barre, PA was
sentenced to serve 12 months' confinement and ordered to pay $1,273.33 in restitution and $668.20 in
court costs. Office of Attorney General special agents had charged Monaco and two co-defendants, Krisandra Lee Strausser and Frank James Capozzi, each with two counts of Insurance Fraud and one count of
Criminal Conspiracy Theft by Deception. According to the Criminal Complaints, Capozzi allegedly
claimed in April 2011 that he was unable to work for his employer, Hindi Beginnings, after he'd been
injured in a motor vehicle accident. According to the complaint, Monaco and Strausser subsequently
signed and presented documents to Allstate Insurance, as purported corporate officers of Hindi Beginnings verifying Capozzi's pre-wage benefits between April and October 2011. When Allstate was unable to
contact Hindi Beginnings directly, they became suspicious. Special agents investigated and found that the
PA Department of Labor and Industry's unemployment compensation records revealed that Capozzi allegedly claimed and received more than $11,000 in unemployment benefits in 2011 to include the threemonth period in which he purportedly worked for Hindi Beginnings prior to the alleged accident. Charg-
“...video surveillance footage
showed Yong had not been
injured as he had claimed as
Yong is seen spilling liquid
on the floor, stepping away
from the spilled liquid,
returning a few minutes later
and intentionally falling on
the spilled liquid.”
es against Strausser and Capozzi were dismissed in August 2013. [OTN: T3827611, T3147885, T3147244]
On December 12, 2014, from a Negotiated Guilty plea to Insurance Fraud, Criminal Attempt Theft by
Deception-False Impression and False Reports, Steve Yong of Philadelphia, PA was sentenced to serve two
years' probation and was ordered to pay $1,500 in restitution and $830 in court costs. On November 5,
2014, from a referral received from Chubb Insurance Company, detectives of the Philadelphia District
Attorney’s Insurance Fraud Unit had filed a Criminal Complaint charging Yong of with Insurance Fraud,
Attempted Theft by Deception and False Reports. According to the complaint, Yong retained counsel to
file a personal injury claim against Sugarhouse Casino claiming that on September 12, 2013, he was in
line for an in-house restaurant when he slipped and fell causing injuries to his back and head, and soft
tissue injuries to his right leg. However, according to the complaint, video surveillance footage showed
Yong had not been injured as he had claimed as Yong is seen spilling liquid on the floor, stepping away
from the spilled liquid, returning a few minutes later and intentionally falling on the spilled liquid. [OTN:
N9394313]
On December 15, 2014, Mollie Darling Stanley of Allentown, PA pled No Contest to Insurance Fraud
and was sentenced to serve 12 months' probation and was ordered to pay a $500 fine and court costs of
$1,387.30. On September 11, 2014, detectives of the Lehigh County District Attorney’s office filed a
Criminal Complaint charging Stanley with Insurance Fraud, Theft by Deception-False Impression, Unsworn Falsification to Authorities and False Reports. According to the complaint, on January 9, 2013,
Stanley’s husband reported a 2012 Wacker Asphalt roller and trailer stolen while working in San Antonio,
TX. Stanley, who is the owner of a paving company, notified Progressive Insurance of the theft. Progressive denied payment of the claim as the trailer had not been covered under her policy. On March 25,
2013, Stanley insured the same asphalt roller with a policy of Main Street America Group Insurance Company. Subsequently, on August 13, 2013, Stanley reported the theft of the same asphalt roller, valued at
approximately $17,000, and a circular saw valued at approximately $1,500, to the South Whitehall Police
Department, and reported that the theft occurred overnight from a Comfort Suites parking lot. Stanley,
on the same date, filed a claim with Main Street America Group and according to the complaint, had
received a payment of $6,221.46 for the alleged loss. [OTN: T5635243]
On December 16, 2014, a Conshohocken, PA woman was granted ARD with two years' probation and
was ordered to perform 50 hours of community service and pay court costs of $1,081.50. Office of Attorney General special agents had filed a Criminal Complaint in November 2013 charging the defendant
Page 14
with Insurance Fraud and Attempted Theft by Deception. The complaint reflects that the defendant's Safe
Auto Insurance policy insuring her 2006 Honda Civic lapsed on June 12, 2012 due to non-payment of premiums. According to the complaint, the defendant was involved in an auto accident when she was struck by
another vehicle on June 17, 2012. The driver of the other vehicle took photos at the time of the incident
which were time-stamped 10:44 AM. The defendant reportedly contacted Safe Auto at 10:58 AM to reinstate
her auto policy and again at 11:52 AM to report the accident and file a claim. Estimated damages to the defendant's Honda Civic totaled $4,244.12. It had been alleged that the defendant, in filing a claim as a result
of the June 17 accident, gave false information in regards to the actual time of the accident as she knew that
her policy had been lapsed and Safe Auto would not be responsible to cover the damages to her Honda.
[OTN: T4032066]
On December 17, 2014, from a Negotiated Guilty plea to Theft by Deception-False Impression, Antwan Lee
Herring of Clairton, PA was sentenced to serve 18 months' probation and was ordered to pay restitution of
$1,364.76 and court costs totaling $814. In October 2013, Herring’s co-defendant was granted ARD with
nine months’ probation and was ordered to pay restitution of $1,364.76 and $1,864 in court costs. Each
defendant had been charged with Insurance Fraud, Theft by Deception and Criminal Attempt Theft by Deception in May 2014 by Office of Attorney General special agents who received a referral from USAA Insur-
“It was alleged that the
ance Company. According to the Criminal Complaints, Herring’s co-defendant added collision, comprehensive and rental reimbursement coverage to her USAA auto insurance policy for a 2004 Chevrolet Trailblazer
on March 30, 2014 at 1:42 PM, and stated that the vehicle hadn’t incurred any damages prior to her adding
defendants increased their
the coverage. The coverage became effective on March 31, 2013 at 12:01 AM. Herring’s co-defendant, subsequently, on March 31, 2013, filed a claim with USAA, stating that on March 30, 2013 at approximately
11:00 PM, the Trailblazer while left unattended due to a flat tire on the side of the road, had been hit by
another vehicle and damaged. On April 2, 2013, during a recorded interview, Herring stated that on March
31, 2013 between 2:00 AM and 4:00 AM, he left the Trailblazer unattended with a flat tire on the side of the
road. He denied that he had struck anything with the Trailblazer or that it was damaged in any way. USAA
USAA auto insurance
policy’s coverage, after the
Trailblazer had sustained
collision damages, to defraud
USAA of the costs of
paid for a rental car at a cost of $1,217.25. The Trailblazer had been towed to a local body shop and an employee there reportedly told USAA representatives that he had observed the damaged vehicle on the side of
repairing the Trailblazer and
the road March 30, 2013 and again on March 31, 2013. Further investigation by USAA, according to the
complaint, concluded that the collision damage to the Trailblazer was not consistent with the Trailblazer’s
the cost of a rental vehicle.”
having collided with another vehicle. Forensic examination showed pieces of concrete embedded in the damaged area of the vehicle and the flat tire to likely have been the result of a collision with a stationary object.
The complaint reflects that repair of the Trailblazer’s damages was estimated to cost $4,308.52. It was alleged
that the defendants increased their USAA auto insurance policy’s coverage, after the Trailblazer had sustained collision damages, to defraud USAA of the costs of repairing the Trailblazer and the cost of a rental
vehicle. [OTN: G6772054, G6772006]
On December 17, 2014, an Edwardsville, PA woman was granted ARD with six months’ probation, was ordered to perform 50 hours of community service and to pay court costs of $1,523.50. On March 18, 2014,
from a referral from Infinity Insurance Company, detectives of the Northeast PA Insurance Fraud Task
Force had filed a Criminal Complaint charging the defendant with two counts of Insurance Fraud. The defendant's auto insurance policy of Infinity was canceled on August 14, 2013 due to non-payment of premiums. According to the complaint, the defendant contacted Infinity on September 5, 2013 at 5:42 PM to
reinstate the policy, and subsequently initiated a claim on September 6, 2013 alleging that her 2003
Mitsubishi Galant, while being driven by another individual, was involved in a two-vehicle crash. The defend-
Page 15
ant stated the crash occurred after she had reinstated her policy. However, according to police reports, Moore
Township Police were dispatched to the accident scene on September 5, 2013 at approximately 5:30 PM; 12
minutes before the defendant’s auto insurance policy was reinstated. [OTN: T4434312]
On December 19, 2014, a Belle Vernon, PA woman was granted ARD with 12 months' probation and was
ordered to pay $1,996.38 in court costs. Office of Attorney General special agents had filed a Criminal Complaint on October 31, 2014 and charged the defendant with two counts of Insurance Fraud and Criminal
Attempt-Theft by Deception. The complaint reflects that the defendant, in December 2011, filed a bodily
injury lawsuit against State Farm Insurance for injuries resulting from an auto accident involving a State
Farm insured. She reportedly claimed that on December 1, 2011, she was a passenger in a parked vehicle
when the vehicle was struck by a State Farm insured, and in an Examination Under Oath, described how the
accident happened and the injuries she claimed she sustained as a result. However, according to the complaint, the investigation revealed that the defendant had not been in the parked vehicle when it was struck,
and that she was observed walking to the vehicle after it had been hit. The defendant subsequently dropped
her lawsuit against State Farm. [OTN: T5833844]
On December 19, 2014, a Colorado Springs, CO man was granted ARD with two years' probation and was
ordered to pay $1,000 in restitution and court costs totaling $417.50. Detectives of the Philadelphia District
Attorney’s Insurance Fraud Unit filed a Criminal Complaint on November 18, 2014 charging the defendant
with two counts of Insurance Fraud and one count of Unsworn Falsification to Authorities. According to the
Several
Defendants
Granted ARD
complaint, on October 12, 2013, the defendant's mother reported to GEICO Insurance and the Philadelphia
Police Department that her son had parked their 2003 Volkswagen outside of a friend’s house in Philadelphia
and later discovered it was missing. The complaint reflects that as there were reportedly multiple reports involving the alleged stolen vehicle, investigators became suspicious. Detectives first retrieved a copy of the Philadelphia PD’s vehicle theft report which stated the defendant had parked the vehicle at a different location
than he had first claimed, and a Non-Reportable Accident Form stated that another citizen had parked his
2010 Nissan Altima on North 13th Street in Philadelphia and later discovered that the car had sustained
damage to the driver’s side door and tire. According to the report, officers noticed a damaged 2003
Volkswagen nearby and later identified it as the same vehicle the defendant had reported stolen. During an
examination under oath, the defendant reportedly admitted that he had crashed his car after leaving a club
with friends and then falsely claimed it had been stolen. The complaint reflects that GEICO had paid over
$17,000 to the defendant's mother for damages to her vehicle and over $10,000 to the owner of the Altima
that the defendant struck. [OTN: N9401700]
On December 19, 2014, a Philadelphia, PA man was granted ARD with two years' probation and was ordered
to pay $1,500 in restitution and $417.50 in court costs. Detectives of the Philadelphia District Attorney’s
Insurance Fraud Unit arrested the defendant in September 2014 and charged him with Insurance Fraud and
Forgery. According to the Criminal Complaint, it was alleged that in April 2014, the defendant had registered
a 2002 Pontiac with a fraudulent Travelers Insurance Company financial responsibility identification insurance card, and on June 18, 2014, presented a Philadelphia Police officer with the same Travelers financial
responsibility identification card. Detectives learned from Travelers that they do not insure the defendant.
[OTN: N9344871]
On December 29, 2014, from a Negotiated Guilty plea to Insurance Fraud and related charges, James I.
Knowling of Henderson, NC was sentenced to serve four years' probation and was ordered to pay restitution
of $9,121.50 and court costs totaling $1,628. The defendant had been charged by the Philadelphia District
Attorney’s Insurance Fraud Unit for taking part in a local attorney’s seven-year operation of a complex insur-
Page 16
ance fraud scheme; a scheme alleged to have defrauded 21 insurers of nearly $400,000, through claims made
on motor vehicle, commercial liability and homeowners insurance policies from staged slip-and-fall accidents.
Andrew H. Gaber, a 52 year-old attorney, who was alleged to have directed the scheme from his Center City
office, reportedly committed suicide after learning that he was to be arrested. [OTN: N9053800]
On December 31, 2014, from a Negotiated Guilty plea to Insurance Fraud, Lamont Pickett (AKA Darryl
Pickett) of Philadelphia, PA was sentenced to serve 12 months' probation and was ordered to pay a $500 civil
penalty to the Insurance Fraud Prevention Trust Fund and court costs totaling $748. Detectives of the Philadelphia District Attorney’s Insurance Fraud Unit had filed a Criminal Complaint charging Pickett with Insurance Fraud and Theft by Deception. According to the complaint, on June 14, 2013, Pickett reported to both
the Philadelphia Police and State Farm Insurance Company that his home had been burglarized and that
electronic devices, including two Apple laptops, over ten video games, and a PlayStation 3 had been stolen
from his home. Pickett provided a Best Buy receipt which listed an itemized transaction of over $4,400 but did
not list a date of purchase or method of payment, and an EB Games receipt for over ten video games and a
PlayStation console. According to the complaint, Best Buy reportedly had no information available on the
purchase made by Pickett and had provided detectives with a copy of their receipt format, which was not the
same as the receipt Pickett submitted to State Farm. Furthermore, many of the purchased games that Pickett
listed on his receipt had not been released until after the date of the supposed purchase, the Game Stop receipt did not match the company’s receipt format, and the listed address for the alleged Game Stop was found
by detectives to be a residential property and had never been used commercially. [OTN: N9341496]
North Carolina
Man to Serve
Probation for
Participating in
Insurance Fraud
Scheme
Page 17
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*April 27-28, 2015 — PA 2015 Insurance Fraud Conference — Hershey Lodge & Convention
Center, Hershey, PA
*September 13-16, 2015 — IASIU 2015 Seminar & Expo on Insurance Fraud — JW Marriot,
Orlando, FL
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Who to Call
Page 18
Insurance Fraud
Allegheny County DA’s Office, (412) 461-2328
Allegheny County PD, (412) 473-1254
Attorney General’s Office, (717) 787-0272
Cumberland County DA’s Office, (717) 240-7764
PA INSURANCE FRAUD
PREVENTION
AUTHORITY
Delaware County DA’s Office, (610) 891-4700
Erie Bureau of Police, (814) 870-1258
Lehigh County DA’s Office, (610) 264-8758
6 Kacey Court, Ste. 101
Mechanicsburg, PA 17055
Montgomery County DA’s Office, (610) 278-3472
Phone: 717-691-1828
Philadelphia DA’s Office, (215) 686-8723
Fax: 717-697-1013
NE Insurance Fraud Task Force, (570) 963-5177
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]
Debra Chamberlin,
Administrative Assistant, [email protected]

Pennsylvania Fraud Stories - Pennsylvania Insurance Fraud

Transcription

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