Pennsylvania Stories AUGUST 2020 Pennsylvania Fraud Prevention Inside this issue: Authority Message from the Executive Director

Welcome to the August Edition of our newsletter. I hope this news-

Public Relations 2 letter finds you and your families safe and well. After a several month hiatus, due to Covid-19, our newsletter is back with our most recent arrest and disposition information. Know the Risks! 3 Our law enforcement grantees have been working hard throughout the pandemic and continued to investigate suspicious claims. Now that the courts have re-opened, they are making arrests and prosecut- Office of Attorney Gen- 3 eral Joins Other Agen- ing those found of committing . I will share our year ThomasRalph BurnhamDonahue cies in Several Com- to date results in the September edition of our newsletter. IFPAExecutive Executive Director Director plex Investigations As you know, our annual insurance fraud awareness conference held in Hershey, PA was Homeonwers Insurance 4 Fraud canceled due to the pandemic. We’re hoping to see everybody at next year’s conference which will be held on Thursday and Friday April 22nd and April 23rd at the Kalahari Re-

Pittsburgh, PA Woman 5 sort and Convention Center in Mount Pocono, PA. Files Several Fraudu- lent Claims for of Due to the increased cost of advertising at this time along with television and radio being Medical Supplies inundated with political advertisements, we’ve decided not to advertise this fall as we have

Know the Penalties! 6 in the past. Instead, we are taking this opportunity to add more commercials to our library and hope to have three new television commercials filmed by the end of the year.

Mark Your Calendar! 9 Thank you again for all that you do in combating insurance fraud in Pennsylvania.

Have a terrific Labor Day weekend and stay well!! Who to Call 10

Page 2 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 3 Fraud Stories

The accounts of insurance fraud and insurance-related 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 July 2, 2020, detectives of the Allegheny County Police Department filed a criminal complaint charging 30 year old Brendon D. Palmer of Bethel Park, PA with Insurance Fraud. According to the complaint, it is alleged that Palmer obtained a Dairyland Insurance auto policy after he had been involved in an auto acci- dent and in reporting the accident to Dairyland, he allegedly misrepresented the accident occurred after he obtained insurance. [OTN: G8682306]

On July 6, 2020, detectives of the Lehigh County District Attorney’s Office filed a criminal complaint charging 41 year old Mark Wickline of Atlantic City, NJ with Insurance Fraud. According to the complaint, it is alleged that when Wickline applied for an auto with Nationwide Insurance, he provid- ed his primary address was Walnutport, PA when in fact, his primary address is in Atlantic City, NJ. [OTN: U8896716]

On July 9, 2020, Office of Attorney General special agents, the Attorney’s Office, FBI, IRS, U.S. Department of Health and Human Services and the Office of Inspector General arrested Dr. Yitzachok Kurtzer, Dr. Lee Besen, Terri Haines, Kimberly Schmidt, Amber Harris, Shanelyn Kennedy and Robin Kurtzer. Charges included to Violate the Federal Anti-Kickback Statute after a lengthy joint investigation. According to the federal criminal complaints, from October 2018 to June 2020, Kurtzer, Besen and others including Kurtzer’s wife, certain employees and business associates, were involved in the collection of patient DNA samples which purportedly would be used in genetic tests pertaining to the pa- tients’ hereditary predisposition for cancer. According to the complaints, patients who were enrolled in Medicare Part B insurance coverage were specifically targeted for these tests, because Part B paid as much as $6,000 for the services. The samples allegedly were routinely collected and submitted to laboratories based in Pennsylvania and New Jersey. The charging documents stated that business associates connected to the labs provided cash payments to the doctors in amounts ranging from $500 to $5,000, based upon the vol- ume of samples provided to the labs for genetic testing ordered by the doctors. The doctors then allegedly provided a portion of the bonuses and kickback payments to office staff members who participated in the scheme. The criminal complaints stated that Medicare was billed more than $1 million for genetic tests generated from Besen’s medical practice and more than $1.3 million for tests generated from Kurtzer’s practice.

On July 13, 2020, Office of Attorney General special agents and the Pennsylvania State Police Organized Task Force arrested Kenneth Torres, Louis Torres, Ruth Negron-Acevedo, Juan Lopez-Barco as well as Philadelphia based businesses EZ Multi-Services and Saul Auto Tags. Each was charged with multiple offenses to include Corrupt Organizations, Dealings in Proceeds of Unlawful Activities, , Conspira- cy, Theft by Deception, and Altered, forged or Counterfeit Documents and Plates. The charg- ing documents state that between June 2017 and September 2019, the defendants used EZ Multi-Services, Saul Auto Tags and other tag agencies to illegally obtain and sell vehicle registrations to customers who lacked valid identification or who wanted to conceal their identities. The defendants allegedly were paid as much as $1,000 for each fraudulently obtained vehicle title and registration. According to the charging documents, the defendants would prepare packets of fraudulent material that included images of Pennsylva-

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Fraud Stories (Continued)

nia driver’s licenses and/or identification cards, forged proof of cards and bogus power of attorney forms. The tag agencies then allegedly submitted the documents to the PA Department of Transpor- tation, which processes applications for PA vehicle titles and registrations. According to the charging docu- ments, the defendants illegally obtained more than 3,000 vehicle titles and registrations, which they sold to paying customers.

On July 13, 2020, detectives of the Allegheny County Police Department filed a criminal complaint charging 62 year old Lori I. Stephens of Cheswick, PA with two counts of Insurance Fraud. According to the com- plaint, on March 1, 2020, Stephens obtained a homeowner/renter’s insurance policy with Travelers Insur- ance Company. On March 2, 2020, Stephens reportedly contacted Travelers to report that her diamond and sapphire bracelet had gone missing sometime prior to March 1st. In support of the claim, Stephens provided Travelers with a photo of the bracelet along with a copy of an appraisal for the bracelet among other jewelry. Travelers issued Stephens a $5,000 check for the lost bracelet. On March 9, 2020, Stephens contacted Travel- ers again, this time to report that a pair of diamond sapphire earrings were also missing. Stephens again pro- vided Travelers with the appraisal and a photo of the earrings that she claimed were missing. According to the complaint, an investigation revealed that the date on the appraisal showed a date of over one month after Stephens claimed she had last seen the earrings, and furthermore, the photo Stephens provided of the ear- rings she claimed were missing was dated March 9, 2020 which was the same date Stephens initiated the claim, and was taken just eight minutes prior to when Stephens contacted Travelers to report the loss. [OTN: G8690404]

On July 15, 2020, detectives of the Bucks County District Attorney’s Office filed two criminal complaints charging 68 year old Ronald Crafton and 65 year old Mattie Samuels-Crafton of Bensalem, PA each with two counts of Insurance Fraud and one count each of Conspiracy and Theft by Deception. According to the com- plaints, on May 2, 2020, the Crafton’s home was damaged after a broken plumbing pipe leaked through the ceiling and caused water damage to the first floor of their home. The complaint alleges that the Craftons conspired to create two fraudulent invoices when they provided false and misleading information on each invoice to make them appear authentic in a reported effort to receive the total recoverable depreciation of $2,709.31, which was being held back until all repairs had been made, and to renew their homeowner’s insur- ance policy. [OTN: U8930165, U8930191]

On July 20, 2020, detectives of the York County District Attorney’s Office filed a criminal complaint charging 32 year old Ryan P. Poole of Hanover, PA with Insurance Fraud and Forgery. According to the complaint, it is alleged that Poole presented a forged receipt to Travelers Indemnity Insurance Company alleging payment for a transmission that cost $900 when in fact, it had only cost $180. Reportedly, Poole later admitted he had only paid $180 for the transmission and that he had provided Travelers with forged receipts in support of his claim. [OTN: U7911175]

On July 22, 2020, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal com- plaint charging 30 year old Matthew W. Leap of Sciota, PA with Attempted Theft by Deception. According to the complaint, Leap filed a claim with USAA Insurance for damage to his 2014 Chevrolet truck, which he reported had occurred in the Pocono Pub parking lot the day before he filed the claim; however, according to the complaint, it is alleged that the damage to the truck resulted from Leap striking his garage while exiting months earlier. Reportedly, Leap later admitted that he knew the claim he submitted was fraudulent and that the damage to his truck was older damage he had hoped USAA would pay for. [OTN: U8955343]

Know the Risks, Know the Penalties Page 5 Fraud Stories (Continued)

On July 21, 2020, detectives of the Delaware County District Attorney’s Office filed a criminal complaint charg- ing 33 year old Jose Garcia of Philadelphia, PA with Insurance Fraud and Attempted Theft by Deception. Ac- cording to the complaint, on December 10, 2018, Garcia filed a claim with Homesite Insurance Company for a laptop that he stated had been dropped and no longer worked. Garcia provided an Amazon receipt for the pur- chase of a new computer that totaled $1,109.03, and Homesite paid the claim minus Garcia’s amount of $250. The complaint states that after Homesite paid Garcia’s claim, the investigation revealed that Garcia did not purchase any computer from Amazon as he had claimed and it was reportedly determined that the Amazon receipt provided by Garcia in support of his claim was fraudulent. [OTN: T5347134]

On July 22, 2020, detectives of the Allegheny County Police Department filed a criminal complaint charging 38 year old Dana M. George of Pittsburgh, PA with four counts of Insurance Fraud. According to the com- plaint, George reportedly obtained homeowner/renter’s insurance policy from Liberty Mutual Insurance Company and subsequently initiated a claim for the theft of a box of diabetic supplies from her porch before she was able to retrieve it. In support of her claim, George supplied Liberty Mutual with a hand written list of stolen supplies, paperwork from Carecentrix resembling an invoice which included an order number, ship- ping date and USPS tracking number, a police report which showed a different incident date than what George reported and a FedEx tracking number showing a different delivery date than George reported to Liberty Mutual. Liberty Mutual paid George $3,695.58 for the claim. The complaint states that George subsequently obtained homeowner/renters policies with Travelers, Lemonade and State Farm Insurance Companies, filed identical claims with each insurer and provided identical supporting documentation with different dates. Travel- ers Insurance paid George $3,860.64, and State Farm paid $3,903.41. However, when Lemonade requested more documentation in support of George’s claim, George reportedly asked to withdraw her claim and Lemon- ade did not pay George any part of her claim. According to the complaint, George made another to file a second identical claim with Travelers Insurance but withdrew her claim when questioned by a special investiga- tor. According to the complaint, George reportedly admitted to investigators that only her first claim was a legiti- mate claim and that the others were all fabricated. [OTN: G8695536]

On July 21, 2020, detectives of the Lehigh County District Attorney’s Office filed a criminal complaint charging 47 year old Juan P. Duran-Plasencia of Allentown, PA with Insurance Fraud. According to the complaint, it is alleged that when the defendant applied for an auto insurance policy with Plymouth Rock Insurance to insure a 2001 Mitsubishi Montero, he stated he was the owner of the vehicle; however, a search conducted of PennDOT records for the vehicle showed the vehicle was registered by another individual. The complaint states that Plym- outh Rock would not have supplied a policy to the defendant for a vehicle in which he had not insurable inter- est. [OTN: U8948170]

On July 22, 2020, detectives of the Allegheny County Police Department filed a criminal complaint charging 54 year old Tina M. George of Natrona Heights, PA with Insurance Fraud. According to the complaint, George filed a claim with Progressive Insurance stating that her vehicle was hit while waiting in a bank drive thru lane by a Progressive insured driver. She stated that her bumper was heavily damaged by the low speed collision. Re- portedly, an investigation revealed that George’s vehicle had prior damage to the rear bumper for which George filed a claim for through Allstate. In support of that claim, George provided photographs of the damage to All- state. According to the complaint, the damage in the photos submitted to Allstate matched the damage George reported to Progressive. It is alleged that George’s claim to Progressive was fraudulent in that she reported prior damage she never had repaired as new damage. [OTN: G8695514]

On July 23, 2020, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 33 year old Raketa Gleason of Philadelphia, PA and charged her with Insurance Fraud, Theft by Deception, Forgery and

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Fraud Stories (Continued)

Criminal Use of Communication Facility. According to the criminal complaint, Gleason filed a claim with USAA Insurance Company after having been involved in an auto accident in December 2018. The complaint states that during the investigation, detectives reportedly determined that the receipts Gleason sub- mitted in support of her claim were false and that she had lied about doctors she claimed had treated her. Ad- ditionally, detectives also found that Gleason submitted receipts for injuries that she sustained prior to the December 2018 accident. USAA did not pay Gleason’s $5,550 claim. [OTN: U2081645]

The Penalties: The following dispositions of cases previously reported on were obtained via

the web portal of Pennsylvania’s Unified Judicial System.

On July 1, 2020, Scheron T. Bryant, Jr. of Brooklyn, NY pled Guilty to Insurance Fraud and was sentenced to two years probation and was ordered to pay $2,853.48 in court costs. On March 27, 2019, detectives of the York County District Attorney’s Office filed a criminal complaint charging Bryant with Insurance Fraud. Ac- cording to the complaint, it had been alleged that when Bryant applied for an auto insurance policy with Pro- gressive Insurance, he stated that he primarily resided and garaged his vehicle at a York, PA address when in fact, he resides in Brooklyn, NY. [OTN: U0180272]

On July 2, 2020, a Pittsburgh, PA man was granted ARD with two years of probation and was ordered to com- plete 50 hours of community service and to pay a $5,000 civil penalty to the Insurance Fraud Prevention Trust Fund, $12,845.07 in restitution and $3,126.75 in court costs. On September 25, 2018, detectives of the Alle- gheny County Police Department filed a criminal complaint charging the defendant with Insurance Fraud. According to the complaint, the defendant reported to his insurer, Erie Insurance Company, that his vehicle sustained some $21,299 in damage as the result of swerving to miss a deer; however, it had been alleged that the defendant damaged his vehicle while participating in a racetrack event. [OTN: G8195283]

On July 6, 2020, from a Negotiated Guilty plea to Insurance Fraud, Robin L. Ritz of York, PA was sentenced to 12 months probation and was ordered to pay $1,666.04 in court costs. On April 3, 2019, detectives of the York County District Attorney’s Office filed a criminal complaint charging Ritz with Insurance Fraud. Accord- ing to the complaint, it had been alleged that Ritz failed to disclose that her sister resided with her and operat- ed Ritz’s vehicle when Ritz applied for an auto insurance policy with First Acceptance Insurance Company. [OTN: U0194106]

In March 2019, Office of Attorney General special agents arrested 11 people and 9 businesses in connection with an insurance fraud scheme involving a substance abuse treatment center. The defendants were each charged with offenses to include Insurance Fraud, Identity Theft, Conspiracy, Unsworn Falsification, Theft by Deception, Corrupt Organizations and Dealing in Proceeds of Unlawful Activities. According to the Attorney General’s March 2019 Insurance Fraud Section’s newsletter, the arrests stemmed from a Statewide Grand Ju- ry’s 18-month long investigation into allegations that drug and alcohol treatment center Liberation Way and its co-founders, Jason Gerner and the late Dallas Fetterman, were running an insurance fraud scheme whereas Gerner and Fetterman, employees and other participants exploited people or persons with drug and alcohol dependencies in order to unlawfully generate millions of dollars in profits. From 2015 through 2018, the de- fendants illegally secured and paid for insurance coverage for Liberation Way patients and billed insurers for services which were sub-standard, not medically necessary, or simply not provided. Liberation Way reportedly billed Independence Blue Cross $115 million dollars for purported treatments alone. It is alleged that the de-

Know the Risks, Know the Penalties Page 7

Fraud Stories (Continued) fendants illegally required patients to live in company-owned housing in order to maximize the amounts that could be billed to insurers. Reportedly, this practice was detrimental to Liberation Way patients and their insurers. Fetterman and Gerner also reportedly developed an elaborate and complex “kickback” scheme wherein thousands of medically unnecessary urine samples were obtained from patients and submitted to Florida-based laboratory facilities for analysis. In turn, the labs billed insurance companies at exorbitant rates for conducting the tests. And when the labs received insurance payments for the services, a portion of the money was sent to Dallas Fetterman and Gerner. When an insurer did not pay for full amount billed, the labs and Liberation Way would reportedly contact patients and their families to collect the unpaid charges. On July 10, 2020, defendant Michael Sarubbi of Cherry Hill, NJ pled Guilty to Insurance Fraud, Theft by Deception and Conspiracy and was sentenced to serve four years probation and was ordered to pay $1,111.75 in court costs. {OTN: U6907471] On July 10, 2020, Dana M. Fetterman of Haddon Township, NJ pled Guilty to Conspiracy and was sentenced to serve two years probation and was ordered to pay $1,111.75 in court costs. [OTN: U6907681]

On July 9, 2020, from a Negotiated Guilty plea to Insurance Fraud, Edward Congo of Philadelphia, PA was sentenced to serve two years probation and was ordered to pay court costs of $5,172.75. On July 9, 2019, Office of Attorney General special agents arrested and charged him with Insurance Fraud, Attempted Theft by Deception, Criminal Use of Communication Facility and Conspiracy. According to the criminal com- plaint, an insured driver contacted Progressive Insurance to report that his car had been in an accident with another vehicle. The following day, Congo’s wife reportedly contacted Progressive and claimed that Edward was a passenger in her vehicle when the accident occurred. According to the complaint, Edward was listed as an excluded driver on the couple’s Progressive policy. Congo and his wife reportedly provided Progressive with medical bills for medical services that they purportedly received after being injured in the crash. Howev- er, police and the other driver confirmed that Edward Congo had been the sole occupant of his wife’s vehicle when the accident occurred. Progressive denied the Congo’s claim. [OTN: U7083775]

On July 15, 2020, from a Negotiated Guilty plea to two counts of Insurance Fraud, Andrew R. Resch of Lititz, PA was sentenced to three years probation and was ordered to perform 50 hours of community service, to pay a $500 fine and court costs of $1,057.75.On February 28, 2020, Office of Attorney General special agents arrested Resch and charged him with three counts of Insurance Fraud and two counts of Attempted Theft by Deception. According to the criminal complaint, Resch contacted Progressive Insurance to report that his vehicle struck a deer. Progressive advised Resch that the deer strike would not be covered under his policy as he did not have comprehensive coverage. Six days later, Resch reportedly added comprehensive cov- erage to his existing policy and subsequently contacted Progressive again to report that he hit another deer. According to the complaint, an investigation revealed that the photos Resch submitted of the purported sec- ond deer strike had been taken the day before Resch added coverage to his policy. Progressive denied the $2,810.63 claim. The complaint states that Resch later purchased an auto policy with Erie Insurance and subsequently filed a claim with Erie for a deer strike. Reportedly, Erie compared the damage that Resch was currently claiming with the damage shown in photos previously submitted to Progressive, and reportedly de- termined that the damage was the same. Erie did not pay the claim. [OTN: U8554744]

On July 21, 2020, a 45 year old female defendant was granted ARD with six months probation and was or- dered to pay a $200 civil penalty to the Insurance Fraud Prevention Trust Fund and $1,620.25 in court costs. On January 14, 2020, detectives of the Bucks County District Attorney’s Office filed a criminal complaint charging a 45-year-old Plainfield, NJ woman with two counts of Insurance Fraud. According to the complaint,

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Fraud Stories (Continued)

it is alleged that when the defendant 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 re- ported that her vehicle had been involved in an accident, she maintained that she resided in Morrisville, PA in Bucks County. [OTN: U8399160]

On July 21, 2020, a Brooklyn, NY man was granted ARD with three months probation and was ordered to pay $742.65 in court costs. On November 22, 2019, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a criminal complaint charging the defendant with Insurance Fraud. According to the com- plaint, it is alleged that when the defendant applied for an auto insurance policy with Progressive Insurance, he provided on the application that his primary address and garaging location of his vehicle was an East Stroudsburg, PA address when he in fact resided and garaged his vehicle in Bronx, NY. [OTN: U7724931]

On July 28, 2020, from a Negotiated Guilty plea to Attempted Theft by Unlawful Taking, Jimmy R. Rodriguez of Manheim, PA was sentenced to serve 12 months probation and was ordered to pay a $200 fine and court costs of $402.75.On July 2, 2019, Office of Attorney General special agents arrested Rodriguez and charged him with Insurance Fraud, Attempted Theft by Deception and Conspiracy. According to the criminal com- plaint, it had been alleged that Rodriguez provided false information to Donegal Mutual Insurance Company stating that repairs had been made to a hail-damaged roof so as the homeowner/claimant could collect recover- able depreciation according to her homeowner policy with the insurer. An investigation revealed that the roof had not been repaired as Rodriguez claimed. [OTN: U7237381]

On July 30, 2020, Christopher Jackson of New Kensington, PA pled Guilty to Attempted Theft by Deception and was sentenced to serve two years probation and was ordered to pay a $100 civil penalty to the Insurance Fraud Prevention Trust Fund and $1,260.25 in court costs. On July 25, 2019, Office of Attorney General spe- cial agents arrested Jackson and charged him with Insurance Fraud and Attempted Theft by Deception. Ac- cording to the complaint, Jackson contacted Progressive Insurance Company to obtain a new auto insurance policy after his policy with Erie Insurance was canceled. Jackson subsequently contacted Progressive to file an accident claim. According to the complaint, it had been alleged that Jackson misrepresented the time of the accident to reflect it occurred after his new Progressive policy was in place. [OTN: U7316901]

Page 9 National & State Anti-Fraud Events Offer New Knowledge & New Contacts

*April 22—23, 2021 — PA 2021 Insurance Fraud Conference — Kalahari Resort & Conven- tions, Pocono Manor, PA

National & State Anti-Fraud Events Offer New Knowledge & New Contacts

Page 10 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]