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The New Jersey Office of the Insurance Fraud Prosecutor

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The New Jersey Office of the Insurance Fraud Prosecutor Annual Report of Annual Report Staff Editor Greta Gooden Brown The New Jersey Insurance Fraud Prosecutor Co-Editor John J. Smith First Assistant Insurance Fraud Prosecutor Co-Editor/Copy Editor Office of the Joan Enright Administrative Analyst Feature Writers Frank P. Brennan, Esq. John Butchko Insurance Fraud Special Assistant John Grady Deputy Attorney General, DOL William Hoyman Deputy Attorney General Prosecutor John Kennedy Assistant Attorney General for Calendar Year 2006 Lewis Korngut Supervising Deputy Attorney General John Krayniak Assistant Attorney General Submitted March 1, 2007 (Pursuant to N.J.S.A. 17:33A-24d) Scott Patterson Supervising Deputy Attorney General Ray Shaffer Administrative Liaison John J. Smith Assistant Attorney General Sherry L. Wilson Deputy Attorney General Contributors Michelle Apgar Supervising Civil Investigator Stuart Rabner, Attorney General Paula Carter Supervising Analyst Greta Gooden Brown, Insurance Fraud Prosecutor Norma Evans Supervising Deputy Attorney General Jennifer Fradel Prepared by: Deputy Attorney General, DOL OFFICE OF THE ATTORNEY GENERAL Charles Janousek Special Assistant Department of Law & Public Safety Pat Miller Administrative Assistant DIVISION OF CRIMINAL JUSTICE Photographers OFFICE OF THE INSURANCE FRAUD PROSECUTOR Carlton Cooper, Civil Investigator Susan Cedar, Administrative Assistant P.O. Box 094 • Trenton, NJ • 08625-0094 Production 609.896.8888 • www.njinsurancefraud.org Paul Kraml, Art Director Enrique Pinas, Graphic Designer Sina Adl, Graphic Designer Administrative and Technical Support Susan Cedar, Administrative Assistant Cynthia Ronan, Administrative Assistant Gina Lemanowicz, Civil Investigator 1 Table of Contents About the Cover The cover of the 2006 Annual Report of the Office of the Insurance Fraud Prosecutor (OIFP) features “Dancing Susan.” Susan represents that category of insurance fraud cheat who claims that she is disabled and unable to perform the duties of her occupation or of her daily life, but still is able to “live it up” on the money obtained from phony insurance disability claims. Cases prosecuted by OIFP demonstrate that insurance cheats who submit phony disability claims include licensed professionals such as doctors, lawyers, podiatrists, State employees, as well as persons from many other walks of life. Phony disability insurance claims can take the form of false submissions to workers’ compensation insurance plans, to Social Security disability, and to other insurance companies to replace lost wages, lost income from a professional business or practice, or to pay off loans and other debts that the claimant claims he can no longer pay because he is purportedly “disabled.” If a person elects to engage in phony disability insurance fraud, he or she can be criminally prosecuted and sent to jail. A person can also be sued for a civil insurance fraud violation and ordered to pay civil penalties and restitution. If the person is a professional licensee, he or she may also suffer loss of his or her professional license. A description of these cases can be found on page 12 of the 2006 Annual Report, and on pages 92 to 93, 110, 113, and 115. 2 Table of Contents Message from the Insurance Fraud Prosecutor: OIFP Scores Supreme Court Victory .............. 40 “Where Do We Go From Here?”.................... 4 The Growing Problem of Rate Evasion .......... 44 OIFP Table of Organization ......................... 8 NJ Insurance Industry’s Perspective on OIFP Year in Review: OIFP Maintains Steady Ambulatory Surgical Centers ...................... 484848 Gains in Criminal and Civil Sanctions ...........10 NJ Legislature Takes Aim at Fraud and 2006 Licensing Sanctions Imposed Abuse in the Medicaid Program .................. 52 on Insurance Professionals by DOBI ......... 21 Closing the Loopholes on Insurance Fraud: 2006 Sanctions Imposed on Licensed OIFP’s 2006 Recommendation for Legislative Professionals by Professional Boards ........ 21 Reform... Extending Immunity for AntiFraud Information Sharing .................................. 58 OIFP Criminal Investigations and Prosecutions Statistics ..................... 222222 Insurance Fraud Prosecutor Case Notes ......... 66 OIFP Civil Investigations Case Index ......................................... 68 and Litigation Statistics ......................... 222222 OIFP Criminal Case Notes .................... 70 OIFP Criminal and Civil Monetary Sanctions and Restitution Summary Putting the Brakes on 99 2001-2006 ........................................ 232323 Unscrupulous Insurance Licensees ........... 99 OIFP Criminal Charges Protecting the Elderly Population ........... 1066 Summary 2001-2006 ........................... 232323 OIFP Civil Case Notes ....................... 10881088 Criminal Cases Investigated in 2006 DOL Civil Litigation Case Notes ........... 1122 by Fraud or Provider Type ...................... 24 Professional Licensing Proceedings ........ 11441144 OIFP and County Prosecutors’ Offices Total Defendants Sentenced OIFP/Government/Industry Contacts .......... 1166 to Jail 2002-2006 ............................... 252525 County Prosecutor Contacts ...................... 1177 New Jersey Observes First Annual Insurance Fraud Awareness Month .......... 26 OIFP Funds County Prosecutors’ Insurance Fraud Fighting Efforts .............. 30 County Prosecutors’ Offices Case Notes ... 323232 OIFP Budget for FY2006 ...................... 38 OIFP Expenditure Report for FY2006 ....... 39 3 A Message from the Insurance Fraud Prosecutor 4 A Message from the Insurance Fraud Prosecutor In 2006, OIFP prosecuted individuals and entities for committing auto, medical, dis- ability, property, and Medicaid fraud in hundreds of cases, some of which bear highlight- ing. For example, OIFP dismantled several large-scale auto theft rings, some of which operated out of car dealerships and solicited, among other things, owner initiated false auto theft claims or “give ups.” These cases also involved the illegal duplication of igni- tion keys through fraudulent locksmithing, the involvement of employees working at the car dealerships, and the fencing of stolen cars across the country on the internet In vouching for OIFP’s sustained through eBay. OIFP’s prosecution recovered over 150 stolen high-end vehicles from the tri-state area valued at over $3 million. success, the most recent report of OIFP also prosecuted a racketeering case involving two lawyers, their law firm, sev- the Coalition Against Insurance eral “runners,” and approximately 28 phony claimants, all of whom were allegedly en- gaged in a scheme to submit phony automobile accident insurance claims in excess of Fraud, a Washington based public $5 million, as part of a corrupt personal injury legal practice. Additionally, the owner of policy and advocacy organization a body shop, two police officers, and seven others were indicted for allegedly staging accidents to obtain over $100,000 in fraudulent auto damage claims, and a licensed chi- for consumer groups and profes- ropractor was convicted by OIFP, along with seven others, for staging accidents in order to submit phony Personal Injury Protection (PIP) claims to five insurance carriers for sionals in the public and private over 300 bogus chiropractic treatments. sectors, once again ranks OIFP as In a sophisticated life insurance fraud scheme, OIFP prosecuted a woman who pled guilty to falsifying nine life insurance claims valued at over $1 million by providing false a national leader in fighting death certificates purporting to establish her own death and posing as her daughter, who insurance fraud. was the designated beneficiary on the policies, in order to collect the proceeds. She col- lected over $700,000 on the false claims before her scheme was detected by the defrauded carriers. An insurance agent was also charged by OIFP and pled guilty in 2006 to falsifying insurance policy applications in order to collect a quarter of a million dollars in up-front life insurance sales commissions. In another life insurance scam, OIFP charged an indi- vidual for falsifying a life insurance application in order to obtain $1 million in life insur- ance benefits on the life of his brother who had perished in the September 11 attack on the World Trade Center. OIFP also convicted a Board Certified plastic surgeon who defrauded four insurance companies out of approximately $1 million by claiming that he was totally disabled and unable to practice plastic surgery when, in fact, he performed dozens of surgical proce- dures. On the eve of trial, the surgeon entered a guilty plea and was sentenced to prison for three years. Following an 11-week-long jury trial, OIFP obtained a conviction of a businessman who had been indicted in connection with his submission of fraudulent insurance claims totaling almost $400,000 arising out of an arson fire at his commercial property. The defendant was convicted of conspiracy, attempted theft by deception, and witness tampering. The jury found that the defendant had, among other things, padded his contents claim by alleging that articles inside his premises had been damaged by the fire when, in fact, no such articles had been in the premises at the time of the fire. The defen- dant was sentenced to 11 years in state prison and is appealing his conviction. In another OIFP trial victory, a Camden police officer was convicted for conspiracy, official misconduct, bribery, and Criminal Use of Runners for his role in selling police accident reports to a retired Camden police officer so
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