Pennsylvania Fraud Stories FEBRUARY 2020 Pennsylvania Insurance Fraud Prevention Inside this issue: Authority Message from the Executive Director
With Major League Baseball’s Spring Training underway in sunny Flori- 2 PA Office of Attorney da and Arizona, I thought it would be a good time to talk about our Insur- General Receives National Prosecutor ance Fraud Awareness Spring Training. Our annual seminar will once Award again be held at the Hershey Lodge in Hershey, PA on Thursday, April 2nd and Friday, April 3rd. Public Relations 3 The conference is attended by Pennsylvania’s and surrounding states’ fraud
Know the Risks! 4 fighters from our insurance, federal, state and local law enforcement com- munities. In addition to excellent break-out sessions hosted by an All-Star team of presenters, the conference is an excellent opportunity for networking ThomasRalph Burnham Donahue Rate Evasion 4 Executive Director and team building among our SIUs and law enforcement communities. IFPA Executive Director
Prescription Fraud 5 During our opening luncheon, we will honor our MVPs of the 2019 season by presenting them with our “Fraud Fighter of the Year” award. If you know of any MVPs deserving of this year’s Fraud Fighter Award, please forward a nomination letter to my attention at [email protected] Preexisting Damage 6 th Claim before March 13 .
Public Adjuster Charged 7 IASIU's examination for CIFI accreditation will be held Thursday, April 2nd from 8:00 a.m. - 10:00 with Insurance Fraud am. IASIU members must visit www.iasiu.org to register and pay required examination fees to IASIU in advance of sitting for examination. Travel Insurance 8 Whether you are interested in attending or exhibiting in our Vendor Hall, click here to preview our conference agenda and then click here to register. Be sure to forward this email on to your col- Know the Penalties! 9 leagues if they've not yet heard the news. Presenters, please use the conference website link to regis- ter and then contact the IFPA's Joan Dockery ([email protected]) for assistance with your travel, lodging and AV needs. Mark Your Calendar! 12 A national Award of Distinction was presented to the Pennsylvania Attorney General’s Office Insur- ance Fraud Section for their prosecution of the Risoldi case. Receiving the award were Linda Who to Call 13 Montag (Pennsylvania Senior Deputy AG), David Augenbraun (Senior Deputy AG) and Adrian Shchuka (Assistant Chief Deputy AG). The award was made by the Coalition Against Insurance Fraud. Please see the full story on the next page.
We are currently working on a new public awareness campaign focused on fraudulent towing claims in Pennsylvania. The campaign titled “Know Your Tow” will be debuting in the next couple of months and will consist of radio ads and videos.
Thank you for all that you do in combating insurance fraud in Pennsylvania!
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CONVICTING LEADER OF BOGUS $20-MILLION FIRE CLAIM EARNS NATIONAL PROSECUTOR AWARD FOR STATE DA’S TEAM
WASHINGTON, D.C., Jan. 6, 2020 — Convicting a prominent Bucks County homeowner who made nearly $20 million of bogus insurance claims for repairing fire damage to her family mansion has earned a national award for the prosecuting team at the state Attorney General’s office. A national Award of Distinction was presented for convicting Claire Risoldi. Receiving the award were Linda Montag (Pennsylvania Senior Deputy AG),David Augenbraun (Senior Deputy AG) and Adrian Shchuka (Assistant Chief Deputy AG). The award was made by the Coalition Against Insurance Fraud. The award honors best courtroom practices and success in earning convictions for exceptionally large, complex and difficult insurance-fraud cases. Insurance fraud is an estimated $80-billion national crime annually, the Coalition estimates. Prominent political fundraiser and socialite Claire Risoldi made national headlines when she tried to collect nearly $20 million in false damage claims after fire swept through the family mansion on Oct. 22, 2013 in New Hope. The state Attorney General’s office oversaw the prosecution of one of the largest home fire- damage insurance crimes in Pennsylvania history. The complex jury trial lasted 3 1/2 weeks. Prosecutors mustered more than 400 exhibits totaling 36,000 pages of evidence to conclusively prove the difficult and sweeping insurance scheme. Numerous forensic experts also testified. Risoldi had claimed $10 million of jewelry was stolen. She falsely blamed the volunteer fire fighters for the theft. Yet forensic evidence showed Risoldi lacked the funds to buy that much jewelry. She also misspelled the word “jewelry” on forged appraisals, and increased coverage on the jewelry from just $50,000 to more than $10 million in the months before the fire. Risoldi also included valuable “irreplaceable” heirloom jewelry in her insurance claim. Yet prosecutors proved she’d claimed the loss of the same jewelry multiple times in prior years. Custom hand-painted wall and ceiling murals of family members also needed restoring at a cost of $1 million, Risoldi claimed. Prosecutors proved the original cost was only about $50,000. Fire destroyed valuable custom draperies and window treatments, Risoldi also said. Yet she falsi- fied invoices to inflate the cost, even misspelling the vendor’s name. Inflated living expenses were claimed as well. Risoldi forged a lease that inflated rental expenses to obtain an inflated lump-sum insurance payment. She also used the money to buy a home while telling her insurer she was merely renting it. The jury convicted Risoldi after deliberating less than four hours. She received up to 23 months in county jail and must repay the insurer $10.4 million.
The Coalition Against Insurance Fraud is a nonprofit national alliance of consumer groups, insur- ance companies and government agencies defending against all forms of insurance fraud.
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Page 3 Public Relations
Visit our website at www.helpstopfraud.org; Be on the look-out for our two Weasy Mobiles driving around Philly & Southeastern PA!
Facebook at www.facebook.com/PennIFPA;
In Central PA, new billboards are popping up!
and on YouTube!
Weasy’s on Facebook too!
https://www.facebook.com/dontbeaweasel/
Know the Risks, Know the Penalties Page 4 Fraud Stories
The accounts of insurance fraud and insurance-related crimes that follow are drawn from Pennsylvania law enforcement’s filed criminal complaints, press releases and newsletters. Criminal complaints dock- eted may be viewed online, using the “OTN” shown in each of the following accounts, through the web portal of Pennsylvania’s Unified Judicial System. Individuals shown charged with crimes are to be pre- sumed innocent until they are proven guilty.
On January 2, 2020, detectives of the Delaware County District Attorney’s Criminal Investigation Division filed two criminal complaints charging 50-year-old Richard Veneri of Woodlyn, PA with Insurance Fraud and Criminal Use of Communication Facility. Veneri’s codefendant, 29-year-old Alisa E. Thomas of Wood- lyn, PA was also charged with Insurance Fraud. According to the complaints, an unlicensed Thomas was reportedly operating Veneri’s vehicle when he was involved in an auto accident. However, when Capitol Insurance contacted Veneri to inquire as to who was operating the vehicle when the accident occurred, Veneri reportedly advised that he was the driver. The complaint states that after Capitol Insurance received the Police Crash Report, they assigned Veracity Research Company (VRC) to investigate the claim, and Veneri and Thomas both reportedly admitted to VRC that Thomas was the operator of the vehicle at the time of the accident. [OTN: U8372652, U8372685]
On January 3, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 27-year-old George O. Headley of Mount Pocono, PA with two counts of Insurance Fraud. According to the complaint, Headley’s vehicle was allegedly involved in an auto accident before he obtained a Progressive Insurance auto policy. When Headley filed the accident claim, he reportedly mis- represented the accident occurred after he purchased his policy. Further alleged is that when Headley ap- plied for the Progressive auto policy, he provided that his vehicle was garaged in Mount Pocono, PA when in fact his vehicle was primarily garaged in Bronx, NY. [OTN: U8365243]
On January 4, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 26-year-old Tywanda T. Reuben of Brooklyn, NY with Insurance Fraud. According to the complaint, it is alleged that when Reuben applied for an auto policy with Progressive Insurance, she misrepresented that she resided and garaged her vehicle at a Blakeslee, PA address when in fact, she is a resident of Brooklyn, NY and primarily garages her vehicle there. [OTN: U8379696]
On January 5 and 6, 2020 respectively, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 28-year-old Emmanuel Wright and 29-year-old Devon Graham, each of Philadelphia, PA and charged each with Insurance Fraud, Identity Theft and Conspiracy. According to the criminal complaints, on March 6, 2019, Graham called New Jersey Manufacturers Insurance Company to report that she was in a car accident with her boyfriend, Emmanuel Wright. The insurance company paid $7,433 for the acci- dent, but it was subsequently determined that Emmanuel Wright’s insurance policy was canceled for non- payment in January 2019. He reportedly contacted New Jersey Manufacturers on the evening of March 5, 2019 to obtain a policy, which became effective on March 6, 2019. The complaint states that police records showed that the car accident happened on March 5, 2019 earlier in the day, prior to Wright obtaining insurance. [OTN: U1936664, U1938064]
On January 6, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 27-year-old Adolph J. Belmont of Brooklyn, NY with Insurance Fraud. According to the complaint, it is alleged that when Belmont applied for an auto insurance policy with Progressive Insur- ance, he misrepresented that his vehicle was primarily garaged at a Tobyhanna, PA address when in fact, it was garaged in Brooklyn, NY. [OTN: U8371311]
On January 6, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 23-year-old Leeanna C. Gavin of Bronx, NY with Insurance Fraud. According to the criminal complaint, it is alleged that when Gavin applied for an auto insurance policy with Progressive
Page 5 Know the Risks, Know the Penalties
Fraud Stories (Continued)
Insurance, she misrepresented that her vehicle was primarily garaged at a Tobyhanna, PA address when in fact, it was garaged in Bronx, NY. [OTN: U8371311]
On January 7, 2020, Office of Attorney General special agents arrested 39-year-old Christina M. Zorio of West Deptford, NJ and charged her with Insurance Fraud, Theft by Deception, Criminal Use of Communica- tion Facility, Forgery and Identity Theft. According to the criminal complaint, Zorio was a former employee at Jefferson Hospital Endocrinology in Philadelphia, PA. During her employment there, she was permitted to verify and call in prescriptions that were prescribed by a medical doctor with the issuing doctor’s NPI authori- zation code. On January 7, 2019, Zorio reportedly called in a prescription for herself using the NPI authoriza- tion code of Dr. Intekhab Ahmed, a doctor at Jefferson Hospital. At the time Zorio called in the prescription, she was no longer an employee at Jefferson. According to the complaint, Dr. Ahmed did not prescribe the medication, nor did he give Zorio permission to use his information. Zorio used her CVS Caremark Insur- ance, picked up the prescription, and signed her name to the CVS receipt after presenting her insurance card and paying the co-pay. The initial prescription was approved and Zorio picked up the prescription. The pre- scription was covered by her insurance and the amount covered was approximately $3,000.00. [OTN: U1926923]
On January 8, 2020, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 25-year- old Kiseam Benson of Philadelphia, PA and charged him with Insurance Fraud and Theft by Deception. Ac- cording to the criminal complaint, in March 2019, Benson was in a car accident when he rear ended a 2013 Nissian Pathfinder operated by a private citizen. At the scene of the accident, Benson was reportedly unable to provide an insurance card. According to the complaint, an investigation reportedly revealed that Benson contacted New Jersey Manufacturers Insurance Company on March 6, 2019 and purchased an auto policy and subsequently filed an accident claim. It is alleged that the accident occurred prior to Benson insuring his vehicle. The complaint further states that Benson also offered to pay cash to the person he hit because he did not have insurance at the time. [OTN: U1928942]
On January 8, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging 72-year-old Fred S. Smalls of Wilmington, DE with Theft by Deception, Theft by Failure to Make Required Disposition of Funds and Deceptive Business Practices. According to the complaint, Smalls was an insurance producer who sold insurance policies to several trainers at PARX Racing and it is alleged Smalls provided several Certificates of Insurance that were fraudulent. The alleged fraud was reportedly discovered when a PARX Racing employee investigated the coverages provided and the respective insurance companies confirmed that the policies did not exist. Insurance companies mentioned in the complaint were Continental Casualty Insurance, Market Insurance, State Workers’ Insurance Fund and Markel Insurance. [OTN: X3117402]
On January 9, 2020, Office of Attorney General special agents arrested 33-year-old Ciara Yarde of Harrisburg, PA and charged her with Insurance Fraud and Attempted Theft by Deception. According to the criminal complaint, on August 6, 2019 at 12:55 PM, Yarde reinstated her automobile insurance policy with Geico Insurance Company. On August 7, 2019 at 8:18 AM, Yarde filed an insurance claim with the Geico stating that on August 6, 2019 at 2:30 PM her vehicle was stolen. However, an investigation reportedly revealed that the vehicle theft occurred prior to Yarde reinstating her automobile insurance policy with Geico. Geico de- nied the $17,000 claim. [OTN: X3119185]
On January 9, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging 55-year-old Linda F. Schiano-Vasquez of Hamilton, NJ with Insurance Fraud and Attempted Theft by Deception. According to the complaint, the defendant reportedly filed an injury claim with the PARX Casino after she claimed she had fallen in a hole in the casino’s parking lot. However, according to the com- plaint, surveillance video footage reportedly showed that Schiano-Vasquez stepped into the hole and sat down but had not fallen into the hole or been injured as she claimed. [OTN: U8384062]
Know the Risks, Know the Penalties Page 6 Fraud Stories (Continued)
On January 9, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging 31-year-old Shaminga L. Davis of Morrisville, PA with two counts of Insurance Fraud and one count each of Theft by Deception, Attempted Theft by Deception and Identity Theft. According to the complaint, Davis submitted a series of auto claims over the past several years and it is alleged that some of the claims were duplicates of other claims. The complaint states that Davis was issued payments for multi- ple claims, and that once Davis received the checks from both State Farm and Geico Insurance Compa- nies, she allegedly called the insurers and would claim that she never received the payments, and the insur- ers would then reissue the payments Davis claimed she never received. According to the complaint, it is alleged that Davis did receive the original checks and cashed or deposited both checks. It is further alleged that she used the identity of her ex-boyfriend to take out another insurance policy and that she submitted false insurance applications by misrepresenting her license status and failing to disclose all her other claims. [OTN: U8383561]
On January 10, 2020, detectives of the Delaware County District Attorney’s Criminal Investigation Divi- sion filed a criminal complaint charging 28-year-old Eudy Martinez of Philadelphia, PA with Insurance Fraud, False Reports and Criminal Use of Communication Facility. According to the complaint, it is al- leged that Martinez filed a damage claim with his insurer, Repwest Insurance Company, on August 30, 2019 for damages that were already present on the vehicle when he purchased it. An investigation reported- ly revealed that a separate claim had been filed on August 6, 2019 with Nationwide Insurance by the vehi- cle’s prior owner after she struck a guardrail. According to the complaint, pictures of the damage from both claims were identical. [OTN: U8397314]
On January 13, 2020, detectives of the Allegheny County District Attorney’s Office arrested 27-year-old Devante L. Mitchell of Pittsburgh, PA and charged him with Insurance Fraud. According to the criminal complaint, Mitchell submitted a damage claim to Progressive Insurance, reporting that his vehicle sus- tained damage after he purchased an auto policy with the insurer. However, it is alleged that the damages to Mitchell’s vehicle occurred prior to the inception of the Progressive policy. The complaint states that Mitch- ell took his vehicle to a Hyundai dealership for repairs, and that auto technicians photographed the vehicle. The date on the photographs taken by the dealership showed that the damages were present before Mitchell obtained the Progressive policy. [OTN: G8576875]
On January 14, 2020, Office of Attorney General special agents arrested 35-year-old Brett Dixon of Mohnton, PA and charged him with Insurance Fraud. According to the criminal complaint, on April 6, 2019 at 11:02 AM, Dixon purchased comprehensive insurance coverage from Geico Insurance Company. On April 8, 2019, Dixon filed an insurance claim with Geico stating that on April 6, 2019 around 12:00 PM, his vehicle caught fire. However, an investigation reportedly revealed that the vehicle fire occurred prior to the Dixon obtaining a comprehensive insurance policy. [OTN: X3129921]
On January 14, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging 45-year-old Julia I. Alvarenga-Herrera of Plainfield, NJ with two counts of Insurance Fraud. Ac- cording to the complaint, it is alleged that when Alvarenga-Herrera applied for an auto insurance policy with Progressive Insurance Company, she provided a Morrisville, PA address when in fact, she resided in New Jersey. And when the defendant reported that her vehicle had been involved in an accident, she main- tained that she resided in Morrisville, PA in Bucks County. [OTN: U8399160]
On January 15, 2020, Office of Attorney General special agents arrested 22-year-old Taylor Booth of Phila- delphia, PA and charged her with two counts of Insurance Fraud and one count each of Attempted Theft by Deception and Criminal Use of Communication Facility. According to the criminal complaint, Booth’s uninsured vehicle was reportedly involved in an accident when the vehicle struck a tree while being driven by her unlicensed boyfriend. According to the complaint, Booth reinstated her Progressive Insurance poli- cy and subsequently submitted a claim and allegedly misrepresented that the accident occurred after her
Page 7 Know the Risks, Know the Penalties
policy was reinstated. Booth reportedly admitted that she misrepresented the facts to Progressive to have the claim paid. [OTN: U8403894]
On January 15, 2020, Office of Attorney General special agents arrested 26-year-old Vidal Q. James of Hatfield, PA and charged him with Insurance Fraud, Attempted Theft by Deception and Criminal Use of Commu- nication Facility. According to the criminal complaint, James had a vehicle that was previously insured with Progressive Insurance Company and the policy was canceled after the initial payment for the policy was re- scinded by the bank. The complaint states that during the time James’ vehicle was uninsured, he was involved in a two-vehicle accident. It is alleged that after the accident occurred, James obtained a new Progressive Insur- ance policy and subsequently submitted a claim for the damages and misrepresented that the accident occurred after he obtained the policy. Progressive subsequently denied the claim. [OTN: U8404152]
On January 16, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging 32-year-old Phineous K. Graham of Camillus, NY with Insurance Fraud. According to the complaint, it is alleged that after Graham was arrested after causing a DUI related accident involving a parked car and boat trailer, he reportedly filed a fraudulent claim with USAA Insurance Company by stating that he struck a deer which caused damage to his vehicle. [OTN: X3133911]
On January 16, 2020, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 47-year- old Michael R. Shelly of Newtown Square, PA and charged him with Insurance Fraud, Theft by Deception, Forgery and Failure to Make Required Disposition of Funds. According to the criminal complaint, Shelly was a public adjuster who defended a family-based business in a claim with Nautilius Insurance Company for a water damage claim on their commercial property. Nautilus paid the $722,486.41 claim to both Shelly and the small family business. Shelly was entitled to 15% of the claim. While investigating, detectives found that Shelly forged the signature of the owner of the business and cashed the checks without giving any portion of the mon- ey to the owner. [OTN: U1938053]
On January 16, 2020, detectives of the Allegheny County District Attorney’s Office arrested 38-year-old Tamara R. Wilkes of Turtle Creek, PA and charged her with Insurance Fraud. According to the criminal complaint, it is alleged that Wilkes obtained an auto insurance policy with Progressive Insurance and subsequently reported that she was involved in an accident after she purchased the policy. However, the complaint states that investi- gators determined through photographs taken and provided by Wilkes in support of her claim that the acci- dent occurred before she purchased the Progressive policy. [OTN: G8576853]
On January 21, 2020, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 24-year- old Markeyta Hyman of Philadelphia, PA and charged her with Insurance Fraud, Forgery, Attempted Theft by Deception and Criminal Use of Communication Facility. According to the criminal complaint, on September 28, 2018, Hyman was reportedly in a car accident and filed an insurance claim with her insurance company, Liberty Mutual Insurance, claiming auto damages, bodily injury and lost wages. Hyman reportedly submitted a forged letter from her employer on company letterhead stating that she had missed 15 days of work. However, according to the complaint, Hyman’s employer reportedly contradicted Hyman’s claim of missing work and confirmed that Hyman had in fact worked on the days she claimed she was unable to work. [OTN: U1943336]
On January 23, 2020, detectives of the York County District Attorney’s Office filed a criminal complaint charg- ing 55-year-old Glenn D. Freyman of Stevensville, MD with Insurance Fraud. According to the complaint, Frey- man’s Donegal Insurance homeowner’s insurance policy required that the residence being insured was an occupied residence. Freyman contacted Donegal on April 4, 2019 to initiate a claim for damage to the insured property. According to the complaint, an investigation revealed that the insured residence had not been occu- pied since March 2018, therefore reportedly making Freyman’s claim fraudulent. The complaint states that repair costs to the damaged residence totaled $6,064.77. [OTN: U7910965]
On January 23, 2020, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 34-year- old James Morgan of Philadelphia, PA and charged him with Insurance Fraud, Forgery, Securing Execution and False Reports. According to the criminal complaint, it is alleged that Morgan registered his vehicle with a bogus financial responsibility identification insurance card of State Farm Insurance. [OTN: U1945856]
Know the Risks, Know the Penalties Page 8
Fraud Stories (Continued)
On January 27, 2020, Office of Attorney General special agents arrested 40-year-old Erin R. Mazzoni of Fur- long, PA and charged her with Insurance Fraud, Forgery and Unlawful Use of Computer. According to the criminal complaint, Mazzoni, the owner of a clothing store in Montgomery County, purchased travel insur- ance through AIG/Travel Guard for a conference in Las Vegas that she and her General Manager were scheduled to attend. The conference was to take place from May 6 through May 10, 2019. According to the complaint, on March 23, 2019, the General Manager emailed a letter of resignation to Mazzoni, which stated that her last day of work would be May 17, 2019. On March 27, 2019, Mazzoni reportedly submitted a claim to AIG/Travel Guard for reimbursement of the $1,237.20 air fare and attached what appeared to be a copy of the General Manager’s resignation letter. However, according to the complaint, Mazzoni had removed the May 17 date from the letter and indicated instead that the General Manager’s last day of work would be in April 2019, which was prior to the conference. AIG reportedly denied the claim because the policy did not cover cancelations resulting from an employee’s voluntary resignation. According to the complaint, Mazzoni appealed the denial and submitted correspondence to AIG which stated that the General Manager was going to be laid off/terminated as of April 13, due to job consolidation measures at the business. The complaint stated that AIG re-affirmed its denial of the claim, based upon the documentation that Mazzoni initially pro- vided. [OTN: X3157000]
On January 28, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 26-year-old Keith J. Fountain of Ashley, PA with Insurance Fraud. According to the com- plaint, it is alleged that when Fountain applied for the reinstatement of his lapsed Progressive Insurance auto policy, he failed to disclose that his vehicle was involved in an accident during the time his policy was lapsed. [OTN: U8449055]
On January 28, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging 31-year-old Tomika O. Padmore of Cambria Heights, NY with Insurance Fraud. Accord- ing to the complaint, it is alleged that when Padmore applied for an auto insurance policy with Progressive Insurance, she provided that she resided at and garaged her vehicle at a Wilkes Barre, PA address when she resided in and garaged her vehicle in Cambria Heights, NY. [OTN: U8449700]
On January 29, 2020, Office of Attorney General special agents arrested 32-year-old Elizabeth M. Painter of Strattanville, PA and charged her with Insurance Fraud and Attempted Theft by Deception. According to the criminal complaint, on July 20, 2019, Painter reinstated a lapsed policy with The General Insurance. On July 23, 2019, Painter filed a claim that she was involved in a single vehicle accident when she struck a pole locat- ed in a gas station parking lot. Painter advised The General that she took photographs of the damages the same day and submitted them in support of her claim. Reportedly, metadata on the photographs showed they were taken prior to the reinstatement of the policy with The General. The General denied the approximate $4,000 claim. [OTN: U8451881]
On January 29, 2020, Office of Attorney General special agents arrested 43-year-old Dwight Fowler-Davis of Philadelphia, PA and charged him with Insurance Fraud, Attempted Theft by Deception and Criminal Use of Communication Facility. According to the criminal complaint, the defendant’s vehicle was involved in a two- vehicle accident on April 23, 2019 with damages sustained to the left rear bumper. An estimate of damages was prepared for the vehicle and on May 7, 2019, Progressive Insurance issued a $1,405.14 payment to Fowler-Davis to repair the bumper. A month later, Fowler-Davis was rear-ended again while driving the vehi- cle and he again claimed the damages to the left rear bumper and represented that he had the vehicle repaired from the previous accident. Reportedly, a picture obtained from a license plate reader a week prior to the second accident revealed that the rear bumper had not been repaired as Fowler-Davis claimed and when con- fronted with the facts and the pictures, Fowler-Davis reportedly confirmed that the damages were the same from the April 2019 accident. [OTN: U8452290]
On January 30, 2020, detectives of the Lehigh County District Attorney’s Office filed a criminal complaint charging 30-year-old Basel Mousa of Allentown, PA with Insurance Fraud and Attempted Theft by Deception. According to the complaint, Mousa allegedly reported to Erie Insurance that he was rear-ended by another vehicle and was pushed into a vehicle that was in front of him which caused damage to his front bumper.
Page 9 Know the Risks, Know the Penalties
Fraud Stories (Continued)
However, an investigation revealed that the damage to Mousa’s vehicle was reportedly pre-existing damage and that Mousa’s vehicle had not been damaged by being pushed into another vehicle as he claimed. [OTN: U8458542]
On January 31, 2020, Office of Attorney General special agents arrested 32-year-old Lashelle R. Washington of Pittsburgh, PA and charged her with two counts of Insurance Fraud and one count of Attempted Theft by Deception. According to the criminal complaint, on July 31, 2019 at 8:55 AM, Washington, who did not have automobile insurance, was the at fault driver in a collision wherein she rear ended another vehicle stopped at a traffic light. At approximately 1:10 PM that same day, she began an online application for a Liberty Mutual Insurance automobile policy and stated that she had no accidents within the past sixty months. Washington telephoned Liberty Mutual Insurance later that day to complete the policy’s inception. The following day, Washington provided her recently obtained insurance policy number to the other driver who then filed a claim with Liberty Mutual. Liberty Mutual denied the other driver’s claim and the driver had to pay his $1,000 de- ductible to his insurance company for the approximate $1,500.00 in damages to his vehicle. [OTN: U8418771]
On January 31, 2020, Office of Attorney General special agents filed a criminal complaint charging 80-year-old Margaret M. Kent of Birmingham, AL with Insurance Fraud and Theft by Deception. According to the com- plaint, it is alleged that Kent has collected some $284,622 in worker’s compensation/death benefits from Alle- gheny Ludlum since the death of her husband, Olen Kent, on July 10, 1987. Kent was eligible for the benefit up until the time she remarried or passed away. According to the complaint, Kent did remarry and failed to notify Allegheny Ludlum and/or its third-party administrator. Kent was required by Allegheny Ludlum and/or Healthsmart, its third party administrator, (Healthsmart previously purchased part of the business of Wells Fargo, that had purchased the business of Accordia), which is based in Houston, PA, to sign and have notarized worker’s compensation/death benefit forms every six months which asked; Are you married at this time? and; Are you cohabitating (living) with a partner? Between February 2005 and November 19, 2018, Kent reportedly submitted the form sixteen times and answered “No” each time she signed the form, when in fact, Kent had remarried on December 21, 2001. Prior to February 2005, Kent never disclosed to Allegheny Ludlum that she had remarried on December 21, 2001. According to the complaint, Kent was not eligible for the benefit from December 2001 through January 2019. [OTN: U8461530]
The Penalties: The following dispositions of cases previously reported on were obtained via
the web portal of Pennsylvania’s Unified Judicial System.
On January 13, 2020, Arthur H. Logan, Jr. of Pittsburgh, PA pled Guilty to Insurance Fraud and was sentenced to 18 months of probation and was ordered to pay $500 in restitution and court costs of $2,173.15. On June 30, 2019, detectives of the Allegheny County Police Department filed a criminal complaint charging Logan with Insurance Fraud. According to the complaint, Logan’s vehicle was reportedly damaged during a time when the vehicle was uninsured. It had been alleged that Logan obtained an auto insurance policy with Progressive Insurance, subsequently filed a claim for the damage to his vehicle and misrepresented that the damage oc- curred after he obtained the Progressive policy. [OTN: G8406462]
On January 13, 2020, Erin N. Brenner of Southampton, PA pled Guilty to Attempted Theft by Deception and was sentenced to 12 months of probation and was ordered to perform 30 hours of community service and to pay a $500 civil penalty to the Insurance Fraud Prevention Trust Fund, $500 in restitution and court costs of $1,449.25. On August 8, 2019, Office of Attorney General special agents arrested Brenner and charged her with Insurance Fraud, Attempted Theft by Deception and Criminal Use of Communication Facility. According to the criminal complaint, it had been alleged that Brenner was involved in an auto accident prior to reinstat- ing her canceled insurance policy with Nationwide Insurance Company. It had been further alleged that when
Know the Risks, Know the Penalties Page 10
Fraud Stories (Continued)
Brenner reported the accident to Nationwide, she misrepresented the time of the accident to reflect her reinstated policy was already in place when the accident occurred. [OTN: X2787960]
On January 22, 2020, Eduardo Contreras of Harrisburg, PA pled Guilty to Insurance Fraud and was sen- tenced to 12 months of probation and was ordered to pay a $100 fine and court costs of $818.75. On Sep- tember 19, 2019, Office of Attorney General special agents arrested Contreras and charged him with Insur- ance Fraud and Attempted Theft by Deception. According to the criminal complaint, at 5:07 PM on Sep- tember 5, 2018, Contreras added full coverage to his Safe Auto Insurance liability policy which covered his truck. At 8:30 AM on September 6, 2018, Contreras again contacted Safe Auto to report that his truck caught fire between 6:00 PM and 6:30 PM the previous evening. The insurer investigated the loss and ac- cording to the complaint, investigators found that firefighters were alerted to the blaze at 4:51 PM on Sep- tember 5th, prior to Contreras adding full coverage to his policy. [OTN: X2883602]
On January 23, 2020, from a Negotiated Guilty plea to Attempted Theft by Deception, Judith L. Smith of Lower Burrell, PA was sentenced to six months of probation and was ordered to pay $851.31 in court costs. On February 13, 2009 detectives of the Allegheny County District Attorney’s Office arrested Smith and charged her with two counts of Insurance Fraud. According to the criminal complaint, it had been alleged that Smith was involved in an auto accident while uninsured, and in reporting the accident, Smith misrepresented that the accident occurred after she purchased a Progressive Insurance auto policy. [OTN: G4509912]
On January 23, 2020, from a Negotiated Guilty plea to Insurance Fraud, Anar K. Rzayev of Pittsburgh, PA was sentenced to 12 months of probation and was ordered to pay $1,571.43 in court costs. On August 2, 2019, detectives of the Allegheny County Police Department filed a criminal complaint charging Rzayev with Insurance Fraud. According to the complaint, it had been alleged that Rzayev had his deductible low- ered after he had been involved in an accident and was not forthcoming as to the actual time of the acci- dent when initiating the accident claim to his insurer, Geico Insurance Company. It had been further alleged that Rzayev had been transporting a passenger for a fee when the accident occurred, which Rzayev denied. [OTN: G8448134]
On January 27, 2020, Cassandra E. Beidleman of Athens, PA pled Guilty to Insurance Fraud and was sentenced to serve 12 months of confinement and was ordered to pay a $500 fine and court costs of $389.25. On June 21, 2019, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging Beidleman with Insurance Fraud and Attempted Theft by Deception. Accord- ing to the complaint, Beidleman’s Permanent General Assurance Corporation (The General) auto insur- ance policy was lapsed from January 13 to January 21, 2019 for non-payment of premium. Beidleman con- tacted The General on February 14, 2019 and submitted a damage claim due to an accident that occurred while her vehicle was being operated by an unknown individual who had stolen the vehicle. Initially, Beidleman reported the accident occurred on January 17, 2019; however, when a claims handler informed Beidleman that her policy was lapsed at that time, Beidleman reportedly changed the date of the accident to January 22, 2019. According to the complaint, it had been alleged that Beidleman fraudulently reported her vehicle had been stolen as she knew that her live-in boyfriend and another individual drove the vehicle to New York to reportedly rob a drug dealer. It had been further alleged that Beidleman misrepresented when the accident occurred as to make it appear her auto policy had been reinstated before the accident occurred. [OTN: U7204691]
Page 11 Know the Risks, Know the Penalties
Fraud Stories (Continued)
On January 27, 2020, James E. Ploumis of York, PA pled Guilty to Insurance Fraud and was sentenced to 23 months of confinement and was ordered to pay $1,146.71 in court costs. On May 2, 2019, detectives of the York County District Attorney’s Office filed a criminal complaint charging Ploumis with Insurance Fraud. According to the complaint, it had been alleged that Ploumis, after being the at-fault driver in an auto acci- dent, presented a different vehicle with no damage than the one he was operating at the time of the crash to a Travelers Insurance appraiser to avoid being found at-fault. [OTN: U7045905]
On January 30, 2020, from a Negotiated Guilty plea to Insurance Fraud and Violating the Controlled Sub- stance Act, Sylvia Marino of Leechburg, PA was sentenced to serve three years in an Intermediate Punishment Program and was ordered to pay a $2,000 civil penalty to the Insurance Fraud Prevention Trust Fund and $8,371.58 in court costs. Marino’s codefendant, Melissa R. Riggle of Lower Burrell, PA from a Negotiated Guilty plea to the same charges was sentenced to serve two years in an Intermediate Punishment Program and was ordered to pay a $600 civil penalty to the Insurance Fraud Prevention Trust Fund and $5,361.58 in court costs. On November 28, 2018, Office of Attorney General special agents arrested Marino and charged her with four counts of Insurance Fraud, Theft by Deception and Violating the Controlled Substance Act and three counts of Forgery. Also arrested was Riggle who was charged with one count each of Insurance Fraud and Violating the Controlled Substance Act. According to the criminal complaints, Marino was a nurse and Riggle was a medical assistant at a neurology practice. It had been alleged that Marino called in or wrote more than 100 fake prescriptions for Oxycodone and Hydrocodone pills for herself, her daughter and for Riggle. Reportedly, Marino used a blank prescription pad belonging to one of the practice’s doctors to write fraudu- lent prescriptions without the doctor’s knowledge. According to the complaints, most of the fraudulent scripts were submitted to UPMC and Highmark Insurance. [OTN: U6521185, U6520824]
On January 30, 2020, Duane Kopera of Patton, PA pled Guilty to Attempted Theft by Deception and was sentenced to 12 months of probation and was ordered to perform 50 hours of community service, to pay a $100 fine and court costs of $1,363.46. On July 9, 2019, Office of Attorney General special agents arrested Kopera and charged him with Insurance Fraud and Attempted Theft by Deception. According to the criminal complaint, Kopera obtained an auto insurance policy with Bristol West Insurance Company and subsequent- ly filed an accident claim stating that his vehicle was damaged by a deer strike. The complaint states that inves- tigators learned Kopera’s vehicle was damaged in an accident that occurred prior to when Kopera obtained the Bristol West policy when his car was insured by Progressive Insurance. According to the complaint, inves- tigators obtained Progressive’s photos of the damaged Malibu, compared them with Bristol West’s photos and determined that the Malibu was damaged while the car was insured by Progressive. [OTN: U7258090]
Page 12 National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*April 2— April 3, 2020 — PA 2020 Insurance Fraud Conference — Hershey Lodge & Con- vention Center, Hershey, PA
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Page 13 Who to Call
Insurance Fraud Allegheny County DA’s Office, (412) 388-5346 Allegheny County PD, (412) 473-1254 Attorney General’s Office, (717) 787-0272 PA INSURANCE FRAUD Bucks County DA’s Office, (215)348-6344 PREVENTION Cumberland County DA’s Office, (717) 240-7764 AUTHORITY Delaware County DA’s Office, (610) 891--4700
6 Kacey Court, Ste. 101 Erie Bureau of Police, (814) 870-1258 Mechanicsburg, PA 17055 Lehigh County DA’s Office, (610) 264-8758 Phone: 717-691-1828 NE Insurance Fraud Task Force, (570) 963-5177
Fax: 717-697-1013 Philadelphia DA’s Office, (215) 686-8723 York County DA’s Office, (717) 771-9600 x 329 www.helpstopfraud.org
Arson PA State Police-Fire Marshals, (717) 346-4597
IFPA Staff
Thomas Donahue, Executive Director, [email protected]
Joan Dockery, Associate Executive Director, [email protected]
Christine Cassel, Grants Administrator, [email protected]