Tag Archives: Insurance Fraud

NICB Predicts Insurance Fraud will Rise with Frequency of Weather-Related Events

The National Insurance Crime Bureau (NICB) predicts a rise in fraudulent claims as weather-related events increase in frequency and size. A study done by the NICB revealed that approximately 10% of insurance claims are fraudulent. Another study fielded by the Pennsylvania Insurance Fraud Prevention Authority (PIFPA) Pennsylvania residents have limited knowledge of what is classified as insurance fraud and even fewer know that it is considered a felony. Insurance fraud, as well as workers’ comp fraud, are not a victimless crime. In fact, it increases policy costs for everyone which is why the industry must proactively combat insurance fraud to prevent further damage.

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Filed under Insurance Fraud

Lake Mary Man Arrested for Posing As Insurance Agent

Michael Hensley of Lake Mary has been arrested for falsely presenting himself as an insurance agent and providing general liability insurance for two Seminole County businesses. This isn’t the first time Hensley’s been accused of posing as an insurance agent and stealing money from local business owners.

While Hensley’s license expired in 2015, he’s pocketed $72,000 in insurance premiums over the years. The business owners would discover that they were not covered when attempting to file a claim.

Claims for damage due to Hurricane Irma uncovered Hensley’s alleged scheme causing one business over to pay $18,000 out of pocket to fix the roof of his business due to the storm.

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Filed under Insurance Fraud

Clearwater Doctor Pleads Guilty to Medicare Fraud

Dr. Jayam Krishna Iyer of Clearwater accepted a plea agreement that will end her medical career. Iyer’s charges include defrauding Medicare by billing for treatments she never delivered and giving written prescriptions for Schedule II narcotics to relatives of patients who never actually stepped foot into her offices.

Iyer’s controversial past includes being sued for malpractice in civil court. She has also been named in death investigations involving narcotics including dilaudid, morphine, oxycodone and fentanyl that she prescribed between 2003 and 2017 in Pinellas County.

Iyer will have to pay $51,000 in restitution for Medicare fraud in addition to giving up her medical career. She was facing up to 10 years in prison and as much as $250,000 in fines, will get a reduced sentence in exchange for her guilty plea.

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Filed under Healthcare Fraud, Medicare

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

FL Insurance Commissioner David Altmaier Warns Homeowners to Protect Themselves

Florida Insurance Commissioner David Altmaier issued a warning to residents facing damage from Tropical Storm Gordon be careful and to make sure they fully read and understand any documents they sign in Gordon’s aftermath. Altmaier has been an outspoken critic of the ongoing assignment of benefits abuse happening in the state of Florida.

Many insurers throughout Florida have been seeing an uptick in litigation due to the inflated and fraudulent claims stemming from unlicensed contractors who have homeowners sign over their insurance policy rights in exchange for needed repairs to their homes.

Florida Chief Financial Officer Jimmy Patronis also issued a warning to consumers to protect themselves against fraud and has activated the Florida Department of Financial Services Disaster Fraud Action Strike Team (DFAST) for the 2018 hurricane season.

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Filed under Assignment of Benefits, Property Insurance

Vero Beach Acupuncturist Charged with Insurance Fraud and Racketeering

Jill Jaynes of Absolute Integrated Medicine in Vero Beach has been arrested and charged with insurance fraud totaling nearly $1.5 million, racketeering and more. If Jaynes is convicted, she could face up to 135 years in prison and millions of dollars in fines.

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Filed under Healthcare Fraud, Insurance, 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

Global Blockchain Expected to Grow in the Insurance Market

Insurance companies globally lose more than US$80 billion to fraud every year. A growing number of fraudulent insurance claims, increasing need to have transparent and trustworthy systems, and a focus on reducing the total cost of ownership will most likely drive the growth of the market.  A new study from ReportLinker projects global blockchain will have a compound annual growth rate of 84.9% between 2018 and 2023 ($64.5M to $1.393.8M) in the insurance market. The identity management and fraud detection segment are expected to hold the largest market size during that period.

The insurance sector of the Asia-Pacific (APAC) area is increasing its adoption of blockchain technology now and is expected to grow the fastest.

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Filed under Insurance, Insurance Fraud

Deltona Man Charged With Arson in Insurance Fraud Scheme

Brian Lee Caswell of Deltona was arrested and charged with second-degree arson, arson resulting in injury, burning to defraud an insurer, giving false information to a law enforcement officer and making a false police report.

According to Caswell’s arrest warrant, he had hatched a plan with Alex Spivey of Orlando and Melinda Philbrook of Lady Lake to destroy their truck and collect an insurance payout. Caswell initially claimed the vehicle had been stolen, but later admitted planning the scheme after co-conspirator Spivey caught fire during the arson.

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Filed under auto insurance, Auto Insurance Fraud, Florida, Fraud, Insurance, Insurance Claims, Insurance Defense, Insurance Fraud