Accused Fraudster Uses Delay Taxes While Victims Continue to Pay

According to the Federal Trade Commission, accused health insurance scammer Stephen J. Dorfman, CEO of Hollywood-based Simple Health Plans LLC, is using “procedural maneuvers” to delay turning over his firm to a court-appointed receiver, giving customers an opportunity to cancel their “worthless” insurance policies.

Dorfman and his company are being accused of duping customers into buying what they thought were comprehensive health insurance plans. Many of them are still paying millions of dollars a month for a product comprised of worthless discount plans and limited-benefit hospital indemnity coverage that pays no more than $3,200 a year.

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Filed under Healthcare Fraud

Orlando Woman Arrested for Arson and Burning to Defraud

Tondra Shenika Roberts was arrested for allegedly setting her car on fire on Christmas Eve. According to police reports, Roberts said the vehicle was supposed to be repossessed and she left the keys inside in case someone showed up to take it.

Investigators found the key in the ignition of the abandoned car as well as a box of matches on the driver’s seat and an empty Heineken bottle with a paper towel inside of it. Lab reports from the car came back positive for gasoline. Roberts said she filed an insurance claim for the damage.

Roberts is facing felony charges of arson and burning to defraud an insurer.

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Boynton Beach Man Accused of Selling Fake License Plates and Insurance Cards

Fedelin Pericles also known as “The Tag Man” was arrested by undercover officers after selling them fake temporary tags and a false insurance card. An anonymous tipster gave detectives Pericles’ phone number and told them that he was providing fraudulent temporary tags for $60 and insurance cards for $100.

On three occasions “The Tag Man” sold three undercover officers two temporary licenses and one fake insurance card. Pericles’ charges include counterfeiting a motor vehicle registration, falsifying records, uttering a forged instrument, organized fraud and driving with a suspended license.

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Stuart OB/GYN Found Guilty in Health Insurance Fraud Scheme

A federal court jury found Dr. Sheetal Kanar Kumar, former Stuart obstetrician and gynecologist, guilty of 23 counts of health insurance fraud. Kumar faces up to 10 years in prison and fines of $250,000 for each charge as a result of her fraudulent claims to Medicare, Medicaid and Blue Cross Blue Shield. Kumar’s claims involved charges for patient office visits involving complex cystometrogram, anorectal manometry, uroflowmetry and voiding pressure studies.

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Ten People Arrested in $42.7 M Insurance Fraud Scheme

Florida Department of Financial Services detectives arrested ten people for using 15 fake clinics to submit 23,000 fraudulent claims totaling $42.7 million. They used fake clinics as drop boxes for insurance payments. Four more arrests are pending with the alleged ring leader, Jorge Valido, still on the run. He previously served time in prison for healthcare fraud.

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Drone and Aerial Imagery Key in the Wake of 2018 Natural Disasters

According to the Insurance Journal, drones and aerial imagery have become very important to the insurance industry as a result of natural catastrophes, particularly in the southeast region of the U.S. Drones allowed insurers to capture the impact of our most recent hurricanes and immediately get to work as claims poured in.

The use of drone imagery of the impacted hurricane areas increased by eight times between mid-August and mid-October 2018 compared with the same period in 2017.

It has become an integral part of claim handlers’ workflow along with the other processes that are already in place.

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Filed under Insurance Claims

Physical Assistant Pleaded Guilty for Role in $1B Medicare Fraud Scheme

Arnaldo Carmouze, a former physician assistant, is facing up to 10 years in prison time for his role in a Medicare fraud scheme. Carmouze was one of three defendants who pleaded guilty to conspiracy to commit healthcare fraud while working for a network of skilled nursing homes and assisted living facilities. The scheme involved admitting Medicare and Medicaid patients to these homes and facilities even if they did not qualify for placement and giving them unnecessary medical care as well as referring patients to certain healthcare providers for kickbacks. In addition to prison time, Carmouze is also facing a fine up to $250,000 and three years of supervised release for his role in the $1 billion Medicare fraud scheme.

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Kendall Man Arrested for Bogus Boat Accident Insurance Claim

Florida Department of Financial Services Bureau of Insurance Fraud investigators arrested Jose Alberto Vargas for allegedly attempting to defraud Boat U.S. out of $14,000. Vargas filed a false claim for a grounded 1993 Mako boat and willfully deceived his insurance company and submitted misleading information regarding the ownership, dates and damage to his boat.

Vargas submitted his false claim on May 31, 2015, a few days after a mechanic saw Vargas’ boat at Tavernier Creek Marina and found that the engine was full of water and one cylinder was bad. Investigators also found that Vargas’ father was the owner of the boat at the time of the “accident” and did not transfer ownership to his son until August of that year.

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Two Arrested in Patient-Brokering and Insurance Fraud Scheme

Licensed pharmacist Richard Vallette and a “middleman” Todd Mulvaney were arrested in patient-brokering and insurance fraud scheme. Vallette and Mulvaney conspired to split thousands of dollars in insurance reimbursements from fraudulent prescriptions with who they thought was a drug-treatment center owner, but turned out to be an undercover cop.

Both men are facing six counts of patient brokering and six counts of insurance fraud. According to the Palm Beach County State Attorney’s Office, this is an active investigation and there will likely be additional arrests.

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Miami Home Health Care Worker Sentenced in Health Care Fraud Scam

Margarita Palomino of Homestead, Florida pleaded guilty to conspiracy to commit health care fraud and wire fraud. Palomino who worked for three home health agencies where she allegedly accepted kickbacks for the referral of Medicare beneficiaries, even ones that did not qualify for home health services and changed claims coding to increase reimbursement by Medicare. Palomino also admitted that she performed home health care nursing visits and prepared related medical records although she does not have a license to do so in the United States.

Medicare made payments of at least $4.65 million as a result of false and fraudulent claims submitted as part of this conspiracy. Palomino was sentenced to over six years in prison to be followed by three years of supervised release for her role in the health care fraud scheme.

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