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.

Click here to read the article.

 

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

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.

Click here to read the article.

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

Filed under Healthcare Fraud

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.

Click here to read the article.

Comments Off on Kendall Man Arrested for Bogus Boat Accident Insurance Claim

Filed under Insurance Fraud

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.

Click here to read the article.

Comments Off on Two Arrested in Patient-Brokering and Insurance Fraud Scheme

Filed under Fraud

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.

Click here for the press release.

Comments Off on Miami Home Health Care Worker Sentenced in Health Care Fraud Scam

Filed under Healthcare Fraud

Judge Unfreezes Personal Assets for Defendant in Health Insurance Scheme

Federal Judge Darrin B. Gayles ruled that Steven J. Dorfman, CEO of Simple Health Plans LLC and accused architect of a massive health insurance scheme, can have $75,000 for legal fees and $5,000 a month from his frozen personal assets. Dorman’s funds were seized when the Federal Trade Commission obtained a restraining order against him and his company in late October. He was initially seeking $15,000/month for living expenses and $200,000 for legal representation to fight the FTC’s lawsuit. The FTC wants to close Simple Health Plans permanently.

Click here to the read full article.

Comments Off on Judge Unfreezes Personal Assets for Defendant in Health Insurance Scheme

Filed under Healthcare Fraud

Brothers Sentenced In Smart Labs Healthcare Fraud Scheme

H. Hamilton Wayne (CEO) and Justin Wayne (COO) of Smart Labs of Palm Beach have been sentenced to prison for healthcare fraud charges they pleaded guilty to back in August. They were also ordered to pay more than $9.6 million in restitution. H. Wayne was sentenced to 63 months in prison, three years of supervised release and a $50,000 fine. His brother Justin received 46 months in prison, three years of supervised release and a fine of $20,000. Justin was a Florida Marlins pitcher from 2002 to 2004.

Click here to read the story.

Comments Off on Brothers Sentenced In Smart Labs Healthcare Fraud Scheme

Filed under Healthcare Fraud

Duval County Public Schools Principal Arrested for Insurance Fraud

Florida CFO Jimmy Patronis announced the arrest of Darrell Perry, a Jacksonville elementary school principal for allegedly trying to submit altered insurance claims and false invoices for over $16,000 in the wake of Hurricane Irma. Investigators found Perry submitted fraudulent and fabricated repair invoices requesting reimbursement from State Farm due to alleged damages from Hurricane Irma.  Perry has turned himself in and now faces up to five years in prison if convicted.

Click here to read the press release.

Comments Off on Duval County Public Schools Principal Arrested for Insurance Fraud

Filed under Insurance Fraud

Crooked Opioid Treatment Center Owner Arrested for Insurance Fraud

James Durkin, owner of a Boynton Beach opioid treatment facility The Hope Center of Recovery, has been arrested for insurance fraud. Durkin was charged for allegedly submitting fraudulent insurance billing for over $104,000.

CFO Jimmy Patronis said, “Insurance fraud at crooked addiction treatment centers fuels the ongoing opioid epidemic in Florida.” An investigation revealed Durkin’s was falsified billings to Cigna and United Health Care for addiction recovery treatments that were never performed.

Durkin faces up to 30 years in prison.

Click here to read the press release.

Comments Off on Crooked Opioid Treatment Center Owner Arrested for Insurance Fraud

Filed under Uncategorized

Pinellas County Detectives Arrest 35 Unlicensed Contractors in Undercover Sting

Pinellas County Detectives arrested 35 unlicensed contractors in an undercover sting operation coined “Operation Cast Out.” The suspects’ charges include unlicensed specialty contracting violations, workers compensation fraud, and various other criminal charges unrelated to unlicensed contracting.

The sting operation was conducted from November 3-5 at a vacant storefront in Madeira Beach. The unlicensed contractors were found advertising on social media platforms and came to the business agreeing to engage in illegal contracting work without a license or permit.

Citizens in Pinellas County can search for licensed contractors or report unlicensed construction activity by visiting the PCCLB website.

Click here to read the article.

Comments Off on Pinellas County Detectives Arrest 35 Unlicensed Contractors in Undercover Sting

Filed under Fraud