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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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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.

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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.

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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.

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Telemedicine Business Owner Pleads Guilty to Fraud

Scott Gregory Roix, owner of the telemedicine company HealthRight, pleaded guilty to conspiracy to commit health care and wire fraud. Roix and his four alleged conspirators, Florida and Texas pharmacists and pharmacy owners are accused of submitting fraudulent insurance claims for more than $930 million.

Healthright made a lot of money illegally selling suspect, inexpensive drugs like weight-loss pills, skin creams and testosterone supplements at inflated prices. Roix’s company also obstructed doctor-patient relationships with telemarketers posing as “medical personnel.” HealthRight hid drug sales to the partner pharmacies by accounting for the payments as “marketing services.”

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Tampa Bay Businessmen Indicted in Billion Dollar Insurance Fraud Scheme

Four Pinellas County businessmen, Andrew Assad, Peter Bolos, Michael Palso and Larry Everett Smith have been indicted on charges of conspiracy to commit health care fraud, mail fraud and introducing misbranded drugs into interstate commerce. The conspiracy involved using their telemedicine business called HealthRight and compounding pharmacy companies to deceive patients, doctors, insurance carriers by fraudulently soliciting insurance coverage information and prescriptions, mark up the prices of the invalidly prescribed drugs, and bill insurance carriers. One of the compounding pharmacies, Alpha-Omega in Clearwater, allegedly charged $374 for $35-worth of lidocaine – a 969-percent markup.

According to the indictment, the men defrauded Blue Cross Blue Shield of Tennessee out of approximately $174,000,000. Another Bay area man, Scott Roix, already please guilty to felony conspiracy in this case and another case involving wire fraud. Assad, Bolos, Palso, and Smith could face prison terms of over 30 years, fines up to $250,000 and probation for their charges.

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Palmetto Bay Man Arrested for Insurance Fraud and Grand Theft

Carlos Guillermo Aponte of Palmetto Bay was arrested in September for three counts of insurance fraud and grand theft for allegedly defrauding Citizens Property Insurance Corp. The Department of Financial Services’ Disaster Fraud Action Strike Team (DFAST) investigated Aponte after receiving a tip about fraudulent invoices and false rental agreements with letters claiming lost of rent for more than $30,000.

Aponte could face prison time of up to 45 years and fines up to $45,000.

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Palm Beach County Business Owner Charged with Workers’ Compensation Fraud

According to the Florida Department of Financial Services, Vanessa Arreguin, owner of V&G Concrete, Inc. was arrested in August for three felony counts of concealing payroll to avoid workers’ compensation premiums and two felony counts of application fraud. Arreguin claimed she made less than $50,000 will conducting more than $7.5 million in business to avoid paying $51,000 in workers’ compensation.

Florida Chief Financial Officer (CFO) Jimmy Patronis said, “Last year alone, our fraud detectives made more than 400 arrests for workers’ compensation fraud and I can assure you my office will continue to hold these individuals accountable.” Arreguin could face up to 20 years in prison if convicted.

Click here to read the press release.

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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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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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