WOMAN ORDERED TO PAY BACK MONEY IN INSURANCE FRAUD CASE

PIKEVILLE, Ky. (WTVQ) – A Pike County woman who admitted to insurance fraud has been ordered to pay nearly $20,000 in restitution, according to the state.

Investigators say 32-year old Courtney B. Saunders, of Pikeville, submitted 39 false medical records to AFLAC totaling $19,380, which the company paid her, according to the state.

Saunders can avoid jail time by reporting to her Probation and Parole officer, remaining alcohol and drug-free, and doesn’t commit further crimes, according to the state.

According to the Coalition against Insurance Fraud, scammers steal approximately $80 billion annually from insurance companies.

Worksite accidents leave migrant workers in the lurch

A rise in the number of worksite accidents notwithstanding, the government’s emergency care schemes have been of little use to migrant workers in Ernakulam, thanks to poor subscription stemming from a lack of awareness about them.

According to the Labour Department’s estimates till June-end, 75,851 migrant workers have been given health insurance cards in Ernakulam. The State government’s Awaaz health insurance scheme for migrant workers provides an annual coverage of ₹15,000 and accident insurance of ₹2 lakh. The district has around six lakh migrant workers according to the State government’s 2018 post-disaster needs assessment. Registration for the district is only done at a centre in Perumbavoor and mobile units are sent out occasionally to register workers.

The Kerala Inter-State Migrant Workers Welfare Scheme, established in 2010 under the Kerala Building and Other Construction Workers Welfare Board, offers ₹10,000 as compensation for temporary disability and ₹50,000 as compensation to the family on the death of the worker. Of the estimated 25 lakh migrant workers in the State, only 9,577 have registered themselves for the scheme till 2018. The Board has not had any registrations this year.

Language barrier

“Workers need to renew their membership with such schemes every year. Going to an office to register themselves will be difficult considering their timings, and language is a barrier. For such welfare schemes to be useful, workers should be able to access them at their convenience,” said Benoy Peter, executive director, Centre for Migration and Inclusive Development.

Construction sites have put their workers, who are mostly migrants with little recourse, at risk. There have been two deaths and at least three accidents in the district in the recent past.

A few weeks ago, a worker from Murshidabad who had been working here for 11 years, fell from an under-construction building in Muvattupuzha and was injured in the leg and back. He was hospitalised for 20 days and medical bills totalled around ₹30,000, said his brother-in-law. The contractor helped the family with only ₹4,000, they had to borrow the rest. He has not recovered entirely yet and they are unsure if he might need a surgery, which they cannot afford.

Lack of evidence

An injured worker can seek recourse under the Workmen’s Compensation Act. The onus is on the owner of the site to provide compensation depending on the injury. “Very few migrant workers are able to approach the tribunal for compensation,” said Bobby Thomas, a lawyer who assists migrant workers. “They cannot appear regularly at the tribunal and such cases can take more than a year to be dispose of.” Besides, there might be no proof that the worker was employed at the site.

“The Labour Department conducts routine inspections at worksites to check for nets, safety belts, helmets and open spaces from where workers can fall,” said V.B. Biju, District Labour Officer (Enforcement).

“Considering the number of construction sites, it is not possible for the department to oversee all of them,” said George Mathew, who has been helping migrant workers seek treatment and compensation. Two workers from Murshidabad died when they fell from an under-construction high-rise at Perumbavoor in May. “If nets were in place, this could have been avoided,” said Mr. Mathew.

A week ago, a 28-year-old worker from Kolkata fractured both his legs when he fell from a construction site at Thuravoor, near Angamaly, said his brother. “No data is available for the number of accidents on construction sites. The family loses its breadwinner if no priority is given to safety on worksites,” said Mr. Peter.

Four Nailed For Insurance Fraud, DA’s Office Says

Four people were charged and have pleaded guilty after an insurance fraud investigation.

The four Bucks Countians that pleaded guilty to insurance fraud charges admitted to filing fraudulent claims in an attempt to get insurance reimbursements for damage to vehicles that did not occur following a June 2017 fuel delivery mix up at the Shell gas station at the corner of New Falls Road and Hood Boulevard.

While the the mix up did happen and damaged a number of vehicles, the four claims signaled out by detectives were fraudulent.

The Falls Township gas station has since been revamped after changing ownership over the past year.

From the Bucks County District Attorney’s Office:

Robert Watts Smith, 63, of Bristol Township, received more than $20,000 from State Auto Mutual Insurance as a result of his fraudulent claims involving multiple vehicles. Some of his claims were denied.

Investigators caught on to his scheme when review of invoices revealed numerous discrepancies in the records related to claims traced back to Smith, despite his use of varying names and addresses. Among the discrepancies were document formatting issues, as well as invalid vehicle identification numbers and license plates that did not match existing records.

In addition to vehicle damage, Smith made phones calls and sent emails demanding additional payments for injury and lost wages to an insurance adjuster and threatened to “go to the media” if his claim was not quickly resolved, a criminal complaint says.

Smith pleaded guilty June 20 before Judge Brian T. McGuffin, who ordered the man to serve six to 23 months in the Bucks County Correctional Facility with a concurrent three-years probation. He also must pay restitution totaling $22,521.08.

He is to report to jail July 19.

Fellow Bristol Township resident Shamsideem Aleem Darden pleaded guilty April 3 to charges stemming from his own false claims. In one instance, Darden claimed his Lexus E350’s engine was replaced as a result of damage from the fuel mix up. In a second, he claimed extensive damage to a Cadillac SRX.

Darden, 40, was sentenced by Judge C. Theodore Fritsch to five years of probation and ordered to pay $19,554.32 restitution.

David Brian Schilling, 52, of Falls Township, alleged his car also needed a new engine, and received $13,152.38 after threatening media attention if his claim was not quickly resolved.

Schilling did appear in at least one news reportclaiming damage to his vehicle over the incident.

He pleaded guilty March 7 before Judge Jeffrey L. Finley and was sentenced to three years of probation. He also must pay back the full amount he received as restitution.

James Christopher Wedul, 45, of Bristol Township, claimed the tainted fuel damaged his Cadillac CTS and received $3,690.13 from the gas station’s insurance company to cover repairs.

Investigators reviewing his claim, however, discovered Wedul did not own a Cadillac. Rather, the only vehicle registered to him was a Ford minivan.

Wedul pleaded guilty April 18 and was sentenced to three years of probation. He also must pay back the full amount he received.

Thief River Falls chiropractor sentenced for insurance fraud

Jun. 19--A Thief River Falls chiropractor who was paid $1.1 million from false insurance claims was sentenced Tuesday for wire fraud and will spend just over two years in prison. Seven related charges were dismissed as part of a plea agreement.

Steven Richard Wiseth, 36, falsely billed insurance companies after hosting events, such as "ValenSpine's Day," at his Thief River Falls clinic, Health Quest Family Chiropractic, according to a federal indictment. From March 2013 to April 2015, he billed insurance companies more than $3.1 million worth of claims and was paid $1.1 million, court documents said.

Wiseth, who opened Health Quest in the early 2010s, would host promotional events where he would give away free food, drink, prizes and gift certificates to prompt current and prospective clients to visit the office. Charges said Wiseth would then bill the insurance companies for services not provided to guests during the events.

During his Feb. 13, 2014, "ValenSpine's Day" event, Wiseth reported to insurers that he provided 641 services to 219 patients during the day, court documents said.

He held a grand opening event in March 2013, when the business moved locations and billed health insurers for 592 services that he claimed were performed on 178 patients.

Widseth routinely billed for a treatment with a "wobble chair," which is a device intended to develop core strength. Widseth claimed he'd spent at least eight minutes with clients individually working on the "wobble chair," but court documents revealed he placed them in waiting rooms so patients would sit in them while waiting for appointments.

Investigation by the Minnesota Commerce Fraud Bureau and the U.S. Postal Inspection Service led to federal charges.

Widseth opened a Grand Forks location in 2014, but it is not mentioned in the indictment.

Four charges of wire fraud and two charges of aggravated identity theft were dismissed as part of a plea agreement. Each wire fraud charge holds a maximum sentence of 20 years in prison.

The sentencing guidelines for Widseth said it would be appropriate to sentence him to 27 to 33 months imprisonment on the first count of wire fraud because of his otherwise clean criminal record and a reduction agreed to during the plea agreement. He was sentenced Tuesday to 27 months in prison.

Judge Patrick J. Schiltz, of the Minneapolis U.S. District Court, said Widseth's fraud was "part of his routine business practice."

After Widseth serves his sentence, he will be on supervised release for a year. He's also ordered to pay $337,195 in restitution and the plea agreement calls for him to forfeit anything purchased from money traceable to the charges.

He is ordered to start serving his sentence by July 22.

Oskaloosa woman gets probation in insurance fraud case

OSKALOOSA , Iowa (AP) - A southeastern Iowa woman has been sentenced to two years' probation and ordered to pay more than $14,000 in restitution and penalties for insurance fraud.

The Iowa Insurance Division said Wednesday in a news release that 39-year-old Brandy Voss, of Oskaloosa, received the deferred judgment Friday.

Mahaska County investigators say that in February 2018, Voss made an insurance claim with her insurance company stating that she had lost valuable property. A month later, Voss sold that same property for a profit. Voss admitted to selling the same property on which she had made the insurance claim.

Arcadia man charged with insurance fraud!

The DeSoto County Sheriff's Office reported the arrest of Frank David Berry III, 37, on charges of insurance fraud and three counts of using a communication device to facilitate a felony. The charges were based on an investigation by the State Department of Financial Services, Division of Investigative and Forensic Services.

According to records from the Clerk of Court, a crash involving three vehicles happened in the Walmart parking lot in December 2017. A man driving a van was backing out of a parking spot when it collided a Mercury approaching in the traffic lane. After the Mercury hit the van, it also struck a Cadillac parked nearby.

Following the mishap, Berry called the insurance company representing the owner of the van. He told the agent he had been in the Cadillac at the time of the collision and saw that the driver of the Mercury was bleeding. He said he did not have his cell phone with him so he left his car and ran into the store to call 911. 

The day after the crash, Berry told the insurance company, he felt a sharp pain in his neck and back from whiplash due to the "violent impact." He said he went to DeSoto Memorial Hospital and Bayfront Punta Gorda for treatment.

However, the driver of the v an said the Cadillac was unoccupied at the time of the crash. His statement was corroborated by a witness who was shopping in the outside garden area at the time of the crash. She said no one had been in the Cadillac at time, and she did not see anyone get out of the car and go to the store. After the crash, she stayed on scene for 30 minutes and never saw anyone leave or return to the Cadillac during that time.

Store security video from the parking lot shows Berry exiting the Cadillac and walking to the store one minute and 24 seconds before the crash of the Mercury, van and Cadillac. After a deputy arrived, Berry was not seen on the video until 22 minutes and 42 seconds after the deputy got there; Berry is then seen pushing a cart to the Cadillac and unloading his purchases when he is told about the crash. He then left the Cadillac and did not return until 44 minutes and 48 seconds later.

Video from inside the store also allegedly showed Berry shopping in various parts of the store during that time.

A doctor who initially saw Berry for treatment later withdrew due to Berry's reported misrepresentation. An attorney for Berry said Berry was withdrawing his personal injury claim and the attorney no longer represented him. 

Berry was arrested on a charge of insurance fraud for less than $20,000 on Sept. 28, 2018, and released on $1,500 bond.

Follow-up investigation reportedly confirmed Berry contacted the van owner's insurance company to make a claim, and he also filed a claim with the insurer of the Cadillac reportedly owned by his girlfriend. A phone call involving Berry, his attorney and the van's insurer was reportedly recorded. 

Berry was arrested again on May 24 on the additional three counts of using a two-way communication device to facilitate a felony. His bond was set at $4,500 and he bonded out the same day.

Yorba Linda man charged after receiving nearly $600,000 in insurance fraud benefits

Federal authorities on Friday charged a Yorba Linda man who prosecutors said used 200 stolen identities to fraudulently bag nearly $600,000 in unemployment insurance benefits.

Jeffrey Silhanek, 39 faces two counts of mail fraud, said the United States Attorney’s Office Central District of California in a news release. Silhanek got his hands on stolen identities and used them to open post office boxes.

Prosecutors said he used the stolen addresses and names to call the California Employment Development Department, fraudulently saying that the individuals were laid off and entitled to unemployment benefits. He instructed workers to send the benefits to the post office boxes he controlled.

Silhanek received $586,000 as a result of the ruse. He is set to be arraigned July 8.