Tag Archives: Fraud

Tampa Bay Roofing Insurance Scammers Busted in Connecticut

Carlton DeWayne Dunko and Frank Martin Pureber, once known for using their former company NBRC Construction in a roofing insurance scam that cheated nearly 100 Tampa Bay residents out of at least $632,000 have taken their talents to Connecticut.

After serving two years in a Florida prison and being placed on probation, Dunko and Pureber fled to Connecticut to start a similar operation, CTST Construction. Dunko was leading a sales meeting in Milford, CT when Florida fraud agents busted him. They have been found guilty of larceny and sentenced to a year in a Connecticut prison.

When Dunko and Pureber finish their Connecticut prison time, they will face trial for the alleged fraud they committed in Missouri with another roofing company, American Shingle and Siding.

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Filed under Insurance Fraud

Owner of Medical Billing Company Pleads Guilty to Healthcare Fraud Scheme

According to the report, Billings USA received or created fabricated bills for its clinic customers. The clinics would then bill insurance companies for allowable amounts and create records to back up the charges.  Billings USA collected a 6% fee on the reimbursement from insurers. Palma’s company filed $5.7 million in fraudulent claims to Blue Cross Blue Shield with one clinic and then an additional $5.9 million in fraudulent claims to Blue Cross and Cigna with another clinic.

Mauricio Palma, the owner of medical billing office Billing USA in Miami, pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to eight years in prison. Palma faces $2.1 million in restitution lost $1.8 million in forfeiture.

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Filed under Fraud, Healthcare Fraud, Healthcare Fraud

Florida Medical Professionals Charged in Largest Healthcare Fraud Crackdown In US History

Over 600 medical professionals in 35 states across the U.S. are on the hook for submitting more than $2B in fraudulent claims in what the U.S. attorney’s office is calling the largest healthcare fraud crackdown in the history of the Department of Justice. Of the 601 charged in this crackdown, almost 150 of the accused are from Florida.

Many of the crimes committed in this crackdown are linked to the opioid crisis, but also includes money laundering, check cashing and billings to Medicare.

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Filed under Fraud, Insurance Fraud

Florida Insurance Agent Suspended Indefinitely for Committing ID Fraud

According to the Ocala StarBanner, Kevin M. Day, 46, used forged documents to open an Allstate branch in Dunnellon. Day pleaded guilty to the fraudulent use of personal identification information of a former client.

Day used the personal information and forged documents signed in the name of a client of his former employer, saying the client would give Day $100,000 to start his own business. At least $100,000 in liquid assets is required by Allstate to open a business.

Day’s former boss investigated the situation and contacted Dunnellon police after Day first tried to buy her business, then opened his own Allstate branch. Day was sentenced to 24 months of probation, his insurance license is suspended indefinitely and he must complete 200 hours of community service.

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Filed under Florida, Fraud, Insurance

Two Miami Medical Clinics Raided for Staged Accidents & Insurance Fraud

Florida’s Department of Investigative and Forensic Services Bureau of Insurance Fraud and the Miami Police Department raided two South Florida medical clinics accused of paying for patients and fraudulent billing. Both clinics have been under investigation since early 2017 for recruiting people for staged accidents and billing insurance companies for thousands of dollars in treatments that they were not providing.

According to Captain Emissael Díaz of Florida’s Bureau of Insurance Fraud “Just in South Florida alone, most of your rates are going to go up 20 to 25 percent just because of the insurance fraud.” The captain stated that schemes of this kind are the reason insurance rates are going in South Florida.

The suspects taken into custody are facing several charges, including patient brokering, insurance fraud and grand theft.

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Filed under Florida, Florida Division of Insurance Fraud, Insurance, Insurance Claims, Insurance Fraud, Miami-Dade County, Miami-Dade Fraud

Palm Beach Post Receives National Recognition for Insurance Fraud Coverage

Washington-based policy and research group, Coalition Against Insurance Fraud, has awarded its inaugural journalism award for fraud reporting to The Palm Beach Post for its work on fraud in the sober-home industry. The award honored Post coverage dating back to 2015 when Post investigators Christine Stapleton and Pat Beall first wrote about how sober-home operators were defrauding insurers of millions of dollars for urine drug tests.

Sober homes were requiring residents to be tested every day, creating multimillion-dollar business empires. Palm Beach County treatment centers and affiliated labs were charging as much as $2,000 for urine tests that can be purchased for $25 at a drug store.

In 2016, a team of Post reporters and editors, including Stapleton, Beall, Lawrence Mower, Joe Capozzi, John Pacenti, Barbara Marshall and Mike Stuck produced “Heroin: Killer of a Generation,” a 12-page special section of stories about 216 men, women and teenagers who died of a heroin-related overdoses in Palm Beach County in 2015. One in 10 had died in a sober home.

The Post’s reporting played a role in the prosecution of sober-home operators Kenneth Chatman and Eric Snyder as well as the successful push to tighten state laws which have resulted in more than 40 people on charges related to brokering patients.

Congratulations to the Palm Beach Post on this national recognition for their work in fighting insurance fraud.

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Filed under Florida, Insurance, Insurance Fraud, Palm Beach County

Panama City Woman Sinks SUV for Insurance Money

According to the Panama City News Herald, 65-year-old Debra Jenkins has been arrested and charged with insurance fraud after having her SUV driven into a lagoon and pretending that the vehicle was stolen. The police had reportedly found a stick inside the vehicle on the driver’s floorboard which appeared to be purposely placed there to hold the gas pedal after the car was removed from the water. Video evidence from Jenkins’ neighbor also showed her SUV leaving her home together with another SUV, then only the second SUV returning that night with two people inside.

Jenkins later admitted to deputies that she and a friend had devised the plan to get rid of the vehicle and claim insurance money.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Claims, Insurance Fraud

UPDATE: Naples Man in Florida Crash Ring Sentenced to 3 Years in Jail

On May 2, 2017, the Coalition Against Insurance Fraud reported that Wisler Cyrius of Naples was sentenced to three years in federal prison after pleading guilty of conspiracy to commit mail fraud and money laundering.

Cyrius and five other individuals conspired to solicit people to participate in staged motor vehicle accidents in exchange for compensation. According to the Justice Department, Cyrius was also ordered by the court to pay restitution to automobile insurance companies and to forfeit property in the amount of the proceeds traceable to the offense.

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Filed under Auto Insurance Fraud, Florida, Insurance, Insurance Fraud

Undercover Investigation Led to Arrests of Bradenton Area Chiropractors

According to ABC Action News, an undercover investigation led to the arrests of two Bradenton area chiropractors and other staff. Detectives say chiropractors Richard Tambe and Yusef Barnes, along with chiropractic assistant Johncina Harrell, performed a fraction of the treatments listed on insurance claims and were billing for treatment never rendered to patients.

The arrests and undercover investigation took place at the Back on Track clinic in Bradenton, Florida. According to the arrest report, all three were booked at the Manatee County Jail on insurance fraud, a third degree felony. Tambe faces 12 counts. Barnes is charged with 8 and Harrell is charged with 13 counts. If convicted each suspect faces as much as 5 years in prison.

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Filed under Florida, Insurance, Insurance Claims, Insurance Fraud, Uncategorized

Four Sentenced For $126 million Florida Healthcare Fraud

Four individuals were sentenced on October 29, 2015 in Florida Federal court for their roles in a large complex scheme to rip off the city of Miami, Miami-Dade County Public Schools and numerous major companies for approximately $126 million in false healthcare claims.

The four major defendants in the case were Hendris Castillo Morales, 33, of Miami; Maite Garcia, 40, of Hialeah; Osvaldo Marin Medina, 48, of Hialeah; and Alejandro Biart, 40, of Miami. They were among 15 individuals who have pled guilty, out of 18 charged in connection with the scheme, according to the U.S. Department of Justice.

U.S. District Court Judge Robert N. Scola handed down prison terms to Castillo for a total of 121 months and Garcia for 48 months. Prosecutors stated that Castillo and Garcia were among four defendants who owned and controlled 30 companies at the heart of the scheme in the Miami area. According to prosecutors, the two used medical director staging companies to misappropriate doctors’ licensing information, which they used to submit false claims to insurers.

Judge Scola set a requirement for both Castillo and Garcia of three years of supervised release. They were also ordered to pay more than $13.8 million in restitution.

In a separate case, U.S. District Judge Urusla Ungaro sentenced both Biart and Medina to 41 months in prison followed by three years of supervised release.

Biart was accused of accepting kickbacks from other defendants in return for referring Cigna, Blue Cross Blue Shield and United Healthcare beneficiaries to medical clinics controlled by Castillo, Garcia and co-defendants Rynaldo Castillo and Lizbet Castillo Batista.

Medina was accused of accepting payments in return for allowing his name to be used to incorporate clinics, open bank accounts and cash checks received from Cigna, Blue Cross Blue Shield and United Healthcare.

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Filed under Miami-Dade Fraud