- Jeff Sanow
Insurance Fraud Hall of Shame
Bride Tied Up in Fraud Scheme Against The Knot
Vermyttya Miller booked a wedding reception through The Knot website, which came with a $10,000 event cancellation/postponement insurance policy. Soon after booking the reception, Miller claimed she tripped on her wedding dress and was injured so severely that she had to cancel the wedding reception and filed an insurance claim under the $10,000 policy. To support her cancellation claim, Miller provided medical reports documenting her injuries. The insurer delivered a $10,000 check to Miller. Then, Miller e-mailed The Knot’s insurer to report her $10,000 check was stolen and provided a forged police report.
Operation Dealer’s Choice Busts Suspects
Four suspects were arrested for alleged involvement in an organized auto fraud ring where dealers purchased damages vehicles and then filed inflated claims and even staged thefts – among other schemes- costing insurers a $500,000 loss. Suspects had the vehicles’ odometer mileages “rolled back” in order to increase the value of the vehicle before it was damages or reported stolen. The remaining vehicles had significant damage prior to being insured unbeknownst to the carrier or are believed to be damaged by the group after being insured.
$3.2 Million Sober Living Home Fraud Scheme Shut Down
Mahyar Mohases, James Frageau, Robert Williams and Nicholas Reeves are accused of finding patients across the country who were seeking help for substance use recovery and flying them to California to enter treatment at Casa Bella International, Inc., which was owned and operated by Steven Lomonaco. In order to obtain payment from the insurance company for the patients, they directed employees to fill out policies for the patients using false information. The information stated that the patients lived in California, when in actuality the addresses were for employees or businesses related to the co-conspirators. Lomonaco paid the others upwards of $10,000 per patient who stayed enrolled in the treatment for more than 30 days.
Suspect extradited from Poland in $2.6 million organized fraud ring
Yeghishe Msryan was extradicted from Poland for his alleged involvement in an organized fraud ring where he and three co-conspirators submitted 50 fraudulent auto loans to receive an unearned $2.6 million in loan payments. Luxor Auto Group, an auto dealer/broker in Glendale submitted 50 fraudulent auto loans for high-end vehicles they claimed they held title to. Luxor provided credit applications, loan contracts, and personal identifying information for supposed buyers. The loans were approved and over $2.6 million was deposited into Luxor’s bank account over the three-month time period. After receiving account statements and payment requests for the vehicles, the majority of the supposed buyers filed police reports for identity theft, stating they never bought the vehicles. After the funds were deposited in the Luxor bank account, the money was laundered out of the account by checks written to an accomplice and/or one of her other businesses.
Farm Worker Arraigned for Alleged Disability Benefits Insurance Fraud Scheme
Eduardo Medina Ruelas was injured when he was struck by a forklift. As a result of his injuries, he was placed on temporary disability and did not return to work. He continued follow-up visits to the doctor, complaining of widespread pain throughout his entire back and most of his body. When it was recommended that he return to work on light duty, Ruelas claimed to be unable to work due to the persistent and severe pain. Surveillance was conducted while Ruelas was off work collecting disability benefits. He was caught on video visiting a casino, shopping, watering his lawn, and transferring a large piano keyboard from the trunk of his vehicle to another vehicle. The surveillance footage showed Ruelas participating in activities that contradicted his claims of injury and inability to work.
Insurance Agent Arraigned for Alleged Financial Elder Abuse
Former Insurance agent Shamron Briggs allegedly stole senior clients’ insurance premiums and failure to place the proper funeral insurance coverage. Briggs sold a funeral insurance policy to a 93-year-old client and collected $2,838 for the premium. Rather than remitting the entire amount to the insurance company to pay for the policy, Briggs allegedly deposited the money into her own personal bank account and made five quarterly payments, totaling $1,235.38 to the insurance company. The remaining $1,602.62 was never remitted by Briggs and resulted in the victim receiving an insurance policy that was worth less than what she expected and paid for. A second victim was identified where Briggs allegedly employed the same scheme, in which she sold a funeral insurance policy to a 90-year-old client and collected $1,600 for the premium. Again, Briggs did not remit any of the premium to the insurance company and instead deposited the funds into her personal bank account and used it for her benefit. As a result, the victim was unknowingly left without the insurance coverage they paid for.
$20 million workers’ compensation insurance fraud and kickback scheme
Bradley Dean Groscost and Felix Koltsov ordered screenings and prescriptions for injured workers in in order to enrich themselves, not to protect their patients. Groscost received $2.1 million in kickbacks from Koltsov, owner of LFPS< Inc. and Resource Pharmacy, Inc., for patient referrals for urine drug screenings and compound cream prescriptions, Koltsov’s companies billed workers’ compensation insurance carriers over $20 million for these claims.
IHOP cook arrested for workers’ compensation fraud
Jonathan Quezada fractured his clavicle while working as a cook at an IHOP. He filed a workers’ compensation claim with his employer stating he got hurt at work while performing his normal job duties and told his employer and insurance representatives that he was cleaning grill grates n the IHOP kitchen when he slipped and fell. An investigation was launched which revealed Quezada lied about the circumstances of his injury. Surveillance video showed he was injured at work, but that his injury was a result of play wrestling with a coworker, not performing his normal job duties as he claimed. His false statements allowed him to receive workers’ compensation benefits he was not entitled to, which cost $22,781.
Operation Car Seats snares family-run ring for alleged auto insurance fraud involving high-end child seats
Lawanda Bogan conspired with family members and close friends to file 32 false insurance claims to an insurer totaling $179,106. They claimed multiple high-end child car seats costing an average of $950 each were in the vehicles at the time of the accidents and submitted fraudulent digitally altered receipts for the car seats to pad their claims to receive higher, undeserved insurance payouts. The car seats accounted for $77,897 of the insurer’s loss. Multiple claims were for accidents that never took place, also called “paper collisions.” To further substantiate the alleged fraud, the suspects digitally altered medical bills and vehicle repair bills.
Hit-and-run suspect attempts to cover up the crime by reporting car stolen
Roberto Garcia filed a stolen vehicle report with the Chula Vista Police Department and reported his vehicle stolen to his insurance company. Garcia claimed his vehicle was stolen after he dropped his keys while out at a bar in Chula Vista the night before. An investigation revealed that the same day he reported his vehicle stolen, he and his girlfriend, were driving when they hit another vehicle, causing minor injuries to a child, and fled the scene. In an attempt to cover-up the hit-and-run collision, Garcia falsely reported his vehicle stolen to the Chula Vista Police Department and to his insurer in an attempt to receive an undeserved $10,000 payout from his insurer.
Source: The Enforcement Branch of the California Department of Insurance