Pennsylvania Fraud Stories
APRIL 2015
Pennsylvania
Insurance Fraud Prevention
Authority
Inside this issue:
Public Relations
3
Know the Risks!
4
A Doctor’s Fraud
4
Hartford Insurance De-
5
frauded of $5,400 in
Bogus Theft Claim
Auto Theft Claim Re-
Message from the Executive Director
W
elcome to the April edition of our newsletter.
6
veals Fraud; Two
It is with great pleasure that I announce the appointment of Christopher
Charged with Insurance
Sloan to the IFPA Board of Directors. Christopher began his insurance
Fraud and Conspiracy
Pre-Existing Damage
career in 1996 as a field investigator specializing in insurance defense
7
Mother Unknowingly
work, and joined PMA in 1999 as a workers’ compensation claims adjuster. Christopher is a graduate of Temple University and received his Senior
Claim
8
Claims Law Associate designation in 2006 and his Certified Insurance
Files Fraudulent Acci-
Fraud Investigator designation in 2007. Christopher’s current role is Cor-
dent Claim to Safe Auto
porate Special Investigative Unit (SIU) Coordinator for PMA Companies.
A Fake Wedding?
9
Ralph Burnham
Thomas
Donahue
Executive
Director
IFPA
Executive
Director
On behalf of the IFPA Board of Directors and myself, I wish to thank Representative Frank Dermody, House Democratic Leader, for the appoint-
Mother and Son Charged
10
with Insurance Fraud
A Policy Obtained Too
Board.
11
Late
Insurance Agent Alleg-
ment of Mr. Sloan. I am confident he will be a valuable asset to the IFPA’s
As we return from our annual fraud conference in Hershey, I want to
12
thank everyone for their hard work and dedication in fighting insurance
edly Pockets Thousands
fraud in Pennsylvania. During the first quarter of 2015, IFPA grantees re-
in Clients’ Premiums
ported 110 arrests. Criminal prosecutions saw 74 individuals convicted with
Auto Body Shop Fraud
13
Auto Body Shop Custom-
14
ers Charged with Filing
Inflated Damage Claims
Know the Penalties!
15
Mark Your Calendar!
20
Who to Call
21
charges against 21 of those individuals diverted to rehabilitative dispositions
Christopher Sloan
PMA Companies
IFPA Board of Directors
(ARD). From prosecutions, defendants were ordered to pay $226,391 in restitution and $19,289 in
fines and civil penalties.
In 2014, there were 3,162 referrals to law enforcement for review. As I mentioned before, the success of the IFPA grantees begins with the investigation conducted by the SIU investigator who makes
the law enforcement referral. I’d like to take a couple of minutes to discuss the importance of a good
referral and the difference it makes in getting a case accepted for investigation. Think of your law
enforcement referral the same as a high school student does his or her college essay. The student
writes the essay hoping to gain the attention of the admissions staff who, in turn, spends more time
and interest on that student’s application. The same applies to a good summary in a law enforcement referral. A good and thorough summary will help the person who reviews the referrals take an
interest in your referral and make an informed decision. A referral with little information will most
likely be declined or placed at the bottom of the pile.
Message from the Executive Director cont’d
I know some of you are reading this and thinking to yourselves, “why should I spend my time writing a good summary when law enforcement doesn’t accept my case or it takes a long time before
it’s accepted?” I can tell you that our largest grantee, the Office of Attorney General, is changing
their review process which will expedite the review of referrals, placing them in the hands of
agents and other grantees at a much quicker pace. The new review process will rely heavily on a
good case summary.
The following is a brief synopsis of the letter being distributed to the industry by the Attorney
General’s office explaining the reason for the new process and a brief description of the new referral process.
“As you may be aware, under our old method, a letter requesting the entire claim file would be sent to your
company immediately after we received a referral. Once we received the complete claim file, we would review
the submitted material to determine if the facts of the case warranted opening a full criminal investigation.
Having the entire claim file was very beneficial for us in reviewing the facts, but ultimately it caused problems
elsewhere. As pointed out by many members of the industry over the years, it was time consuming and potentially costly for the industry. It also delayed our review process, and backlogged cases as volumes upon volumes
of claims files were received. With the steady increase in referrals being received, what was once beneficial had
instead become burdensome. A new process has been developed, and now has been fully implemented across
the Section.
Every week, Supervisory Special Agents in each region will review incoming referrals. They will make a recommendation to the prosecutors with regards to opening or denying a referral. The recommendation will be made
based upon the facts detailed and articulated in the summary provided by the SIU in his or her referrals. Insufficient or poorly articulated referrals may result in the case being denied. The Office will only request the entire claim file from your company if we are accepting the case for a full criminal investigation. Occasionally, your SIU may get a call requesting additional documents or supporting material, but by
and large, we are going to use the wording in the provided summary to triage the referral and determine the
direction of the case. The final decision on every referral will be made by the Deputy Attorneys General assigned to the Section. This will put the burden on the SIU to draft a complete summary that will highlight the
alleged fraudulent acts and false statements that were made, and which will articulate what evidence is available to support the allegations. Some SIUs do this very well already. I am hoping that this new process will
benefit the industry by helping to alleviate the unnecessary preparation of files for cases which ultimately will
not be investigated.”
I’d like to thank Chief Deputy Attorney General Jim Fitzpatrick and Senior Supervisory Special
Agent Josh Tison for their hard work in developing and implementing this new process.
Thanks again to all involved in combating insurance fraud in the Commonwealth of Pennsylvania.
Page 3
Public Relations
Winning! In the war against insurance fraud, that is. PA Fraud Fighters’ work generate the cases from
which we draw our fraud prevention messages. We’re pleased to see that Pennsylvania’s series of award
winning fraud prevention videos are now available to all insurers, state fraud bureaus and anti-fraud
groups, at little or no cost, through the national Coalition Against Insurance Fraud. Contact Kendra
Smith at 202-393-7330.
Perhaps you’ve seen the TV spot where a young lady in a job interview finds herself
in the difficult position of having to admit that she’d been arrested for insurance
fraud. She blurts out that she’d gotten mixed up in a faked injury scheme and
was fined and put on probation. The message is clear, that bad decision is going to haunt her for the rest of her life.
Or, maybe you’ve seen the TV ad where a man takes notice of the progress of his neighbor’s home repairs.
A hail storm, a storm-chasing fly-by-night contractor, improperly done
repairs and mechanics liens placed on the property were the ingredients
of this spot’s message to consumers to be wary of deals that sound too
good to be true.
Would our posters or brochures assist your fraud prevention and fraud awareness training efforts?
View our online store and order—there’s no cost or charge.
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 docketed 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 presumed innocent
until they are proven guilty.
On March 2, 2015, from a joint investigation with the Region V Strike Force, Office of Attorney General
special agents arrested 39 year-old Dr. William Ainsley of Hopwood, PA and charged him with three counts
of Insurance Fraud, six counts each of Acquire or Obtain Possession of Controlled Substance and Administration of Controlled Substance by Practice and one count of Conspiracy. According to the Criminal Complaint, between January 9, 2012 and August 7, 2014, Ainsley is alleged to have prescribed hydrocodone to
patients who had agreed to return all or a portion of the Schedule III controlled substance to him for his own
personal use once they had obtained the prescription by use of their individual prescription insurance plans.
The complaint states that Ainsley wrote nearly 200 prescriptions for the hydrocodone in quantities of 40, 50,
“...between January 9, 2012
and August 7, 2014, Ainsley
is alleged to have prescribed
hydrocodone to patients who
60, 90 and 120, and the majority were then shared with Ainsley. The prescriptions were filled at various pharmacies in the Uniontown area to include Walgreens, Hixenbaugh’s, CVS, Giant Eagle and Walmart. Victimized insurance companies listed in the complaints include CVS Caremark and Highmark Express Scripts.
[OTN: T6265696]
Patients who allegedly participated in Ainsley’s prescription fraud scheme are as follows:
·
Carl Eugene Santavicca, 62, of Uniontown, PA; charged with Conspiracy, Acquire or Obtain Possession of Controlled Substance and Manufacture, Delivery or Possession with Intent to Manufacture or Deliver. [OTN: T6266735]
·
Deven L. Saghy, 46, of Uniontown, PA; charged with Insurance Fraud, Conspiracy, Acquire or
Obtain Possession of Controlled Substance and Manufacture and Manufacture, Delivery or Possession with Intent to Manufacture or Deliver. [OTN: T6265851]
·
Robert C. Woleslagle, 57, of Uniontown, PA; charged with Conspiracy, Acquire or Obtain Possession of Controlled Substance and Manufacture, Delivery or Possession with Intent to Manufacture
or Deliver. [OTN: T6266654]
·
Palmer Frank Sabatine, 42, of Uniontown, PA; charged with Insurance Fraud, Acquire or Obtain
Possession of Controlled Substance and Manufacture and Manufacture, Delivery or Possession with
Intent to Manufacture or Deliver. [OTN: T6266046]
·
Rendell Keith Rice, Jr., 27, of Uniontown, PA; charged with Conspiracy, Acquire or Obtain Possession of Controlled Substance and Manufacture, Delivery or Possession with Intent to Manufacture
or Deliver. [OTN: T6266886]
·
Scott Eugene Bloom, 43, of Hibbs, PA; charged with Insurance Fraud, Conspiracy, Acquire or Obtain Possession of Controlled Substance and Manufacture and Manufacture, Delivery or Possession
with Intent to Manufacture or Deliver. [OTN: T6266540]
had agreed to return all or a
portion of the Schedule III
controlled substance to him for
his own personal use...”
On March 2, 2015, Office of Attorney General special agents filed a Criminal Complaint in Blair County
charging 33 year-old Michael Shawn Traveny of Altoona, PA with two counts of Insurance Fraud and one
count of Criminal Attempt Theft by Deception-False Impression. According to the complaint, Traveny obtained an auto insurance policy through Safe Auto Insurance Company on August 21, 2014 at approximately
Know the Risks, Know the Penalties
Page 5
Fraud Stories (Continued)
6:44 PM. During the application process, Traveny reportedly stated that he had not been involved in an accident
nor had his vehicle sustained any damages in the past three years. The complaint reflects that Traveny was involved in a two-vehicle accident on August 21, 2014 at 6:30 PM; however, Safe Auto had not paid for damages
done to Traveny’s vehicle or the vehicle he rear-ended as Traveny had not obtained his Safe Auto insurance
policy until after the accident occurred. Damages to the vehicle that Traveny struck were estimated to be
$3,902.40. [OTN: T6270084]
On March 2, 2015, Office of Attorney General special agents filed a Criminal Complaint in Luzerne County
charging 56 year-old Guy Scott Gruber of Kingston, PA with Insurance Fraud and Theft by Deception-False
Impression. According to the complaint, Gruber submitted a claim on May 6, 2011 to Hartford Insurance
Company reporting that he discovered jewelry missing from his home. However, the investigation revealed that
the jewelry Gruber reported missing was the same jewelry he had taken to New York City and sold to a jeweler
for $900. According to the complaint, agents were able to obtain a copy of the transaction receipt as confirmation that Gruber had sold the jewelry he had fraudulently reported missing. The complaint reflects that Hartford
had paid Gruber some $5,400 for the supposed missing jewelry. [OTN: T6268743]
On March 2, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 27 year-old
Amy D. Martin of Pittsburgh, PA with two counts of Insurance Fraud and one count of Theft by Deception.
According to the complaint, on August 18, 2014 at approximately 3:51 PM, Martin contacted Safe Auto Insurance Company and obtained a liability policy to insure a Pontiac Grand Am. Martin had reportedly stated at
that time that there had been no prior accidents or damages done to her vehicle in the last three years. On August 18, 2014 at 4:07 PM, a business owner contacted Safe Auto to report an accident involving one of his drivers that occurred at approximately 3:00 PM. The investigation revealed that in that accident, Martin had been
the driver of the vehicle that rear-ended the business’ vehicle, and it was alleged that Martin hadn’t obtained the
Safe Auto liability policy until after the accident occurred. No money was paid on the claim. [OTN: G7039922]
On March 2, 2015, Office of Attorney General special agents filed two Criminal Complaints charging 48 yearold Robin Marie Holloway and 27 year-old Robert Dwane Nichols, both of Philadelphia, PA with two counts of
Insurance Fraud and one count each of Conspiracy and Criminal Attempt Theft by Deception-False Impression.
According to the complaints, it was alleged that Holloway and Nichols had provided fraudulent information to
Allstate Insurance Company when filing an accident claim for an accident that occurred on January 31, 2013 in
Philadelphia. The defendants stated that Holloway had been operating the 2012 Mercedes Benz C300 when it
was involved in a crash with an Allstate insured 2002 Lexus ES300; however, when interviewed, the driver of the
Lexus stated that Nichols had been operating the Mercedes at the time of the accident, not Holloway. According
to the complaint, Nichols filed a claim on February 12, 2013 alleging the crash had aggravated pre-existing neck
and back injuries, and Holloway claimed property damage to the Mercedes. Allstate had not paid either claim.
[OTN: L9256085, T6270456]
On March 2, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 40 year-old
Tracy Lynn Ayers of McKeesport, PA with Insurance Fraud, Theft by Deception, Forgery and Identity Theft.
According to the complaint, on January 24, 2013, Ayers was involved in a single-vehicle crash and was transported by emergency medical services to a local hospital for treatment of a fractured shoulder. Ayers, in support of a
claim, provided a Wage and Salary Verification form indicating that she was employed as a home health aide
from April 2009 until March 2013. Ayers claimed on the form that she was providing medical care aide to her
boyfriend’s father at the time and was being paid cash for her services. Ayers had reported on the form that she
was unable to work from January 2013 through March 2013 as a result of injuries she sustained in the accident,
claiming $1,134 in lost wages to State Farm Insurance Company. Further investigation revealed that Ayers was
Kingston, PA
Man Charged
with Insurance
Fraud After
Selling Jewelry
and Later
Reporting It
Had Been
Stolen
Page 6
Know the Risks, Know the Penalties
Fraud Stories (Continued)
not and never had worked for her boyfriend’s father as a health care aide and was never paid by him for any
services. [OTN: G7044936]
On March 3, 2015, from a referral received from Infinity Select Insurance Company, detectives of the
Northeast Pennsylvania Insurance Fraud Task Force filed two Criminal Complaints charging 31 year-old
Cherill M. Flores Torres of Wilkes-Barre, PA and 41 year-old Maribel Mahuiztl of Plains, PA each with two
counts of Insurance Fraud and one count of Conspiracy. According to the complaints, on October 13,
2014, Flores initiated a claim against Infinity alleging that her 2012 Ford Explorer had been stolen. Flores
advised that she owns three vehicles and that due to the lack of parking space at her residence, she garages
the Explorer at Mahuiztl’s residence. Reportedly, through further questioning, Flores admitted to detectives
that she was not the owner of the Explorer. Flores alleged that Mahuiztl had asked Flores to put the Explorer in her name as Mahuiztl was in the United States illegally and was unable to obtain a driver’s license. The
complaint reflects that on April 24, 2014, Flores had completed an application for title for the Explorer and
provided an Infinity policy number, a policy in which Flores obtained by posing as the owner of the vehicle
“...Flores had completed an
application for title for the
Explorer and provided an
Infinity policy number,
which she obtained by posing as the owner of the
vehicle in order for and
unlicensed driver to have a
valid policy.”
in order for Mahuiztl, an unlicensed driver, to have a valid insurance policy on the vehicle. [OTN:
T6276233, T6279523]
On March 3, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 49 yearold Doris K. Rorie of Philadelphia, PA with Insurance Fraud. According to the complaint, Rorie in applying for a loan and disability credit insurance through CMFG Life Insurance Company on June 29, 2011,
stated on the application that she was physically working at least 25 hours per week. Rorie obtained the loan
and disability credit insurance at that time. Then, on June 24, 2012, Rorie filed a claim with CMFG Life
claiming that she had been injured at work. However, when agents contacted Rorie’s listed employer, it was
revealed that Rorie had been on unpaid medical leave when she applied for the policy, and according to the
complaint, CMFG denied Rorie’s claim. [OTN: T6245094]
On March 3, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 28 yearold Jim Emmanuel Rochelin of Wilmerding, PA with two counts of Insurance Fraud and one count each of
Criminal Attempt Theft by Deception-False Impression and Theft by Deception. According to the complaint, Rochelin was involved in a single-vehicle crash on July 16, 2014; the same date he reinstated his Safe
Auto Insurance auto policy. Rochelin reportedly had not disclosed that he had just been involved in the
crash. According to the complaint, he subsequently filed a claim with Safe Auto and stated that the accident
had occurred at approximately 9:00 AM, after he had reinstated his policy; however, police reports from the
Monroeville Police Department show the time of the accident as 7:57 AM. The complaint reflects that
Rochelin had not reinstated his policy until 8:10 AM on the 16th. Safe Auto had not paid the claim. [OTN:
G7039922]
On March 3, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 35 yearold Rashad Saleen Wyatte of Philadelphia, PA with two counts of Insurance Fraud and one count of Theft
by Deception-False Impression. According to the complaint, on February 26 and 27, 2013, and again on
May 30, 2013, Wyatte stated to Liberty Mutual Insurance Company that he had been the driver of his
2010 Buick when it was struck by a Liberty Mutual insured 2000 Toyota Rav 4. Wyatte sought medical
treatment for injuries he alleged he had sustained as a result of the accident, and on February 14, 2013, had
filed a personal injury claim under his wife’s Esurance Insurance Company auto policy. On August 26,
2014, agents interviewed the driver of the Toyota who reportedly stated that he was driving his Toyota when
his vehicle struck a Buick owned by Wyatte; however, Wyatte had not been the driver of his vehicle but
Know the Risks, Know the Penalties
Page 7
Fraud Stories (Continued)
rather another individual, and that there were no other occupants in the vehicle at the time of the accident.
And further, when informed of an injury claim Wyatte made as a result of the accident to Liberty Mutual, he
stated that Wyatte had not been an occupant of the vehicle at the time of the accident, and again stated that
someone else was driving Wyatte’s vehicle at the time. Agents subsequently obtained a copy of a Philadelphia
Non-Reportable Accident Report which listed Wyatte as the owner of the Buick, but that another individual
had been driving the Buick when it was struck by the Toyota, and that there were no passengers in either
vehicle at the time of the accident. It was alleged that Wyatte provided fraudulent information to both Liberty
Mutual and Esurance in an effort to obtain benefits he was not entitled to receive. The complaint states that
Esurance had paid Wyatte $1,590 in medical bills; however, Liberty Mutual had not paid Wyatte’s claim.
[OTN: T6260704]
On March 4, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 41 year-old
Angel Harp Achatz of Vandergrift, PA with two counts of Insurance Fraud and one count of Theft by Deception-False Impression. According to the complaint, it was alleged that Achatz, in an effort to obtain an auto
insurance policy of Safe Auto Insurance Company, had not disclosed that she had just been involved in a
two-vehicle accident in which she was the at-fault driver. The driver of the other vehicle subsequently filed a
claim against Achatz’s newly obtained Safe Auto policy. According to the complaint, when Safe Auto contacted Achatz about the claim, she stated that the accident had occurred at 2:00 PM when in fact, the accident
had occurred at 11:30 AM, prior to her new policy’s inception. State Farm had paid $883.48 to include Anchatz’s $250 deductible to settle the claim. [OTN: T6281634]
On March 4, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 23 year-old
Joanna Clari Adams of Lancaster, PA with Insurance Fraud and Criminal Attempt Theft by Deception-False
Impression. According to the complaint, Permanent General Assurance Corporation (PGAC) canceled Adams’ auto insurance policy on January 3, 2012 for non-payment of premiums. On January 16, 2012, Adams
contacted PGAC to report that she had almost been involved in an accident and asked a representative that if
the accident had actually occurred, would her vehicle have been covered. When advised that her policy had
been canceled, Adams reportedly made a $50 payment to the insurer to have her policy reinstated, effective
January 17, 2012. Adams subsequently contacted PGAC on January 17, 2012 and claimed that her car had
just been damaged in a hit-and-run accident. During a February 4, 2012 recorded interview, Adams reportedly
admitted that the accident had actually taken place on the 16 th just before she called PGAC to reinstate her
policy. PGAC denied Adams’ claim. [OTN: T6280072]
On March 4, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 49 year-old
Brett William Kronk of Carmichaels, PA with Insurance Fraud and Conspiracy. According to the complaint,
on April 24, 2014, Kronk claimed that he had been involved in a vehicle crash when he struck a deer with his
Ford Escape on April 23, 2014. The Escape had been added to his girlfriend’s Progressive Insurance policy
on April 19, 2014. Kronk claimed $3,427.03 in damages to his driver’s side headlight, fog light, front fender,
front door, rear door handle and quarter panel and stated that there had been no prior damage. Investigation
revealed that the Escape had been involved in another claim with Allstate Insurance on June 18, 2013, which
was filed by the Escape’s prior owner. Allstate paid that claim in the amount of $2,747.67, and according to
the complaint, much of the damage that had been submitted to Allstate was similar to that submitted to Progressive. Progressive’s appraiser estimated new damage caused in April 2014 to be $875.30, and that the other
damages were pre-existing. [OTN: T6279980]
Carmichaels,
PA Man Alleged
to Have Filed
Claim with
Progressive for
Pre-Existing
Damages
Know the Risks, Know the Penalties
Page 8
Fraud Stories (Continued)
On March 5, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 37 year-old
Seth A. Propheter of Corry, PA with Insurance Fraud. According to the complaint, it was alleged that Propheter, in an effort to have his lapsed Safe Auto Insurance Company auto insurance policy reinstated, had failed
to disclose that he had been involved in a two-vehicle crash on August 10, 2014 during the time his auto policy was lapsed, and further did not disclose that he used his vehicle for transporting individuals for business
purposes. The complaint reflects that had Propheter disclosed his accident just prior to reinstating his policy,
his premiums would have been calculated at a substantially higher rate and further, had Propheter informed
Safe Auto that he used his vehicle to transport individuals for business purposes, Safe Auto would not have
insured him. [OTN: T6284622]
On March 6, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 32 year-old
Samuel J. Buckwalter, Jr. with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression.
The complaint states that Buckwalter was involved in a single-vehicle accident on April 13, 2014 at approximately 8:00 AM when he drove his vehicle through the front yard of a neighbor causing damage to her proper-
Mom
Unknowingly
Files Fraudulent
Accident Claim
ty and his 2006 Chrysler Sebring. According to Economy Boro police reports, police responded to the scene at
approximately 8:00 AM and parts of the vehicle were collected at the scene. The complaint further states that
on April 13, 2014 at 8:10 AM, Buckwalter’s mother contacted Safe Auto Insurance Company to add full
coverage insurance to Buckwalter’s Sebring, and two days later, filed a claim for the vehicle alleging that the
Sebring had been involved in an accident on April 15, 2014. Buckwalter reportedly admitted to obtaining full
coverage after the accident on April 13, 2014 and that his mother had not been aware that the accident actually occurred on the 13th when reporting to Safe Auto that it occurred on the 15 th. [OTN: T6287584]
On March 6, 2015, Office of Attorney General special agents arrested 21 year-old Sandra Shabazz of Darby,
PA and charged her with two counts each of Insurance Fraud, Theft by Deception-False Impression and Criminal Attempt Theft by Deception-False Impression. According to the Criminal Complaint, on March 28,
2012, a two-vehicle crash occurred when a Liberty Mutual Insurance Company insured Ford Taurus hit an
unoccupied Honda Civic parked in the middle of the street in Philadelphia, which was insured by Allstate
Insurance Company. The driver of the Taurus reportedly stated that she pulled over to the side of the road
and it was then that she noticed the defendant coming out of a house and becoming upset. The Taurus’ driver
went on to state that when emergency personnel arrived, Shabazz allegedly told them that she had been in the
Honda at the time of the collision. On March 29, 2012, Shabazz filed a claim with Allstate for personal injuries she had allegedly suffered as a result of the accident, and on April 25, 2012, gave a recorded statement to
Liberty Mutual stating the same. Further witness interviews revealed that Shabazz had not been in the Civic
when it was hit, and both of the defendant’s claims against Allstate and Liberty Mutual were denied. [OTN:
T6281203]
On March 11, 2015, detectives of the Erie Bureau of Police filed a Criminal Complaint charging 61 year-old
Domingo Vazquez of Erie, PA with Insurance Fraud and Giving False Information. According to the complaint, on December 5, 2014, Vazquez contacted Erie Police to report that his 1996 Pontiac Firebird had been
damaged in a hit-and-run while parked outside his apartment, and subsequently on December 10, 2014, reported the same to Progressive Insurance Company. According to the complaint, officers viewed video surveillance footage of the apartment complex parking lot, which shows Vasquez walking out of his apartment on
November 28, 2014 with a tool in his hand, approaching his vehicle, striking the vehicle with the tool and
then using the tool in a prying motion to pry the bumper from the fender. No other vehicle is shown hitting
Vasquez’s vehicle. Progressive did not pay the claim. [OTN: T6307663]
Know the Risks, Know the Penalties
Page 9
Fraud Stories (Continued)
On March 11, 2015, detectives of the Erie Bureau of Police filed a Criminal Complaint charging 37 year-old
Fred E. Dobbs, III of Erie, PA with Insurance Fraud. According to the complaint, Dobbs claimed he had
been injured when he was struck by a vehicle backing up. Dobbs, on July 22, 2014, filed a claim with Capitol
Insurance and stated that he had been struck while standing next to the vehicle that he alleged had backed
into him, and further stated that he was unable to work at Better Baked where he makes $9.75 per hour.
Then, on September 10, 2014, a Capitol Insurance representative interviewed Dobbs with his attorney present and Dobbs stated that at the time of the accident, he had been working as a cook at Applebees making
$10.25 per hour, but had reportedly not mentioned ever working for Better Baked as he had initially claimed.
Detectives subsequently contacted Applebees to confirm Dobbs’ employment, at which time they learned that
Dobbs had not been hired at Applebees until July 31, 2014. Detectives then contacted Better Baked Foods an
learned that Dobbs had in fact worked there through a temporary staffing service and verified that Dobbs
worked on dates that he claimed he was unable to work due to his injuries from the accident. Capitol did not
pay Dobbs’ claim. [OTN: T6307593]
“On June 4, 2011,
On March 11, 2015, detectives of the Erie Bureau of Police filed a Criminal Complaint charging 29 year-old
Dominique N. Selby of Erie, PA with Insurance Fraud and False Reports. According to the complaint, on July
Eberwein and his “to-be
10, 2014 at 12:49 AM, Selby reported to Erie Police that she had parked her 2003 Infinity outside her apartment at 8:00 PM on July 9, 2014. She claimed that she had been awakened by a noise at approximately 12:30
spouse” had a wedding
AM on the 10th and discovered that her vehicle’s windows had been broken and the driver’s side on the exterior and interior of the vehicle had been spray painted. Both outside rear view mirrors were also broken. On
ceremony and reception;
July 21, 2014, Selby was interviewed by a 21st Century/Farmers Insurance representative and in a recorded
statement, claimed the same. She advised she was in possession of the vehicle’s one and only key and claimed
that no one else had driven the vehicle. According to the complaint, detectives viewed photos of the damage
and observed that the broken mirrors were missing parts that were not seen on the ground and the broken
window glass was not present to the extent of the windows having been broken. Detectives had reportedly
obtained photos of Selby’s vandalized vehicle pulling into the parking lot at 12:10 AM on July 10 th while being driven by an unknown male. Detectives then viewed the video surveillance in its entirety and discovered
that the defendant arrived home at 8:39 PM on the 9th but that she was driving a Hyundai Santa Fe, not the
Infinity, and the only time the Infinity is seen is at 12:10 AM on the 10 th, already damaged and being driven
by an unknown male who is then seen approaching Selby’s front door. The two are reportedly seen a short
time later approaching the vehicle together. [OTN: T6307534]
On March 11, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint
charging 40 year-old Melvin Leroy Eberwein, III of Dover, PA with two counts of Insurance Fraud and one
count of Theft by Deception-False Impression. According to the complaint, Eberwein was an employee of
REAL Services, Inc., where he had spouse and family medical coverage through the company’s employee
health benefit program, Highmark Insurance, from July 1, 2011 until August 15, 2012. On June 4, 2011,
Eberwein and his “to-be spouse” had a wedding ceremony and reception; however, the complaint states that
unbeknownst to Eberwein’s “spouse” and guests who attended the ceremony, the wedding was fictitious as
there was reportedly no marriage license. On July 1, 2011, Eberwein changed his medical coverage to include
his wife and her son, which increased the benefit cost for REAL Services, Inc. A Highmark fraud investigator
reported that Highmark had paid some $10,100.24 in claims for services rendered to Eberwein’s wife and her
son; however, had Highmark known that the defendant hadn’t legally married, the company would not have
insured either. [OTN: T6305434]
however, the complaint
states that unbeknownst to
Eberwein’s “spouse” and
guests who attended the
ceremony, the wedding was
fictitious as there was
reportedly no marriage
license.”
Know the Risks, Know the Penalties
Page 10
Fraud Stories (Continued)
On March 11, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint
charging 23 year-old Charles Elliott Coe and his mother, 42 year-old Eugenia Ruth Stokes, both of York, PA,
with Insurance Fraud, Criminal Attempt Theft by Deception-False Impression and Conspiracy. According to
the complaint, Coe owned a 2004 Nissan Murano insured with GEICO Insurance Company through his
mother. On December 21, 2012, Coe had been involved in a single-vehicle crash while operating the Nissan.
The complaint reflects that Stokes had contacted GEICO on December 21, 2012 to add collision and comprehensive coverage to the Nissan, and on December 24, 2012 at approximately 10:43 AM, Coe was interviewed by a GEICO investigator and reportedly stated that he had taken a cab home after his crash and that
he did not tell his mother about the crash until a couple of days prior to the interview that the accident had
been a two-vehicle crash. Investigators interviewed Stokes who related that she was not aware of the crash
until December 23rd, when she returned home from church. On February 12, 2015 at approximately 8:15
AM, Stokes reportedly admitted that she had been aware of the crash when she called GEICO to obtain the
“The complaint states that
Vega had previously filed
personal injury claims
additional coverage to the policy. Stokes stated that the damages to the Nissan totaled some $6,000; however,
GEICO did not pay the claim. [OTN: T6302181, T6302122]
On March 12, 2015, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 63 yearold Deborah A. Vega of Philadelphia, PA and charged her with Insurance Fraud and Theft by Deception.
against SEPTA on two
According to the Criminal Complaint, on November 13, 2012, Vega was a passenger on a Southeastern
other occasions and had
Pennsylvania Transportation Authority (SEPTA) bus when the bus had a minor collision with a parked
2002 Honda Odyssey. Vega subsequently retained counsel to file a personal injury claim on her behalf, claim-
received settlements of
ing that the accident had caused her to suffer injuries to her back and legs and that she had incurred medical
bills in excess of $12,000 as a result. The complaint states that Vega had previously filed personal injury
$8,505.”
claims against SEPTA on two other occasions and had received settlements of $8,505. Digital surveillance
footage from the SEPTA bus reportedly shows that after the bus made contact with the Honda, the operator
brought the bus to a stop. The footage shows that no passengers appeared to be disturbed, and Vega can be
seen moving about the bus with no evidence of distress revealing that she had not been injured as she had
claimed. [OTN: N9545480]
On March 13, 2015, detectives of the Lehigh County District Attorney’s Insurance Fraud Unit filed a Criminal Complaint charging 53 year-old Gary Francis Dohn of Brooklyn, NY with Insurance Fraud. According to
the complaint, Dohn applied for auto insurance on July 7, 2014 with the PA Assigned Risk Plan and on
application, listed an Allentown, PA address as his primary address and vehicle garaging location. Reportedly,
on August 5, 2014, an analyst reviewing Dohn’s application discovered that Dohn’s listed phone number
contained a New York area code, which subsequently prompted a PA Assigned Risk investigator to verify that
the defendant’s address was actually that of Brooklyn, NY. [OTN: T6312434]
On March 16, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint
charging 36 year-old Kelly Lynn Holda of Manchester, PA with Insurance Fraud and Criminal Attempt Theft
by Deception-False Impression. According to the complaint, on July 11, 2013, Holda reported to State Farm
Insurance Company that her home had been burglarized and that three motorcycle motors, six wheels and
scrap metal had been stolen. Holda, subsequently on July 28, 2013, signed and prepared a personal property
inventory customer worksheet listing the stolen items. And on September 12, 2013, in support of her claim,
Holda provided State Farm with an invoice for the three motorcycle motors and a notarized Will, which listed
Holda as the owner of the alleged stolen items. According to the complaint, Holda later admitted that she
had never purchased the motorcycle motors on the invoice and that she had created the fake Will in an at-
Know the Risks, Know the Penalties
Page11
9
Page
Fraud Stories (Continued)
tempt to make State Farm believe she owned the alleged stolen items. State Farm had not paid Holda’s claim,
valued at some $18,375. [OTN: T6321383]
On March 16, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint charging 44 year-old Michelle D. Lehman of Etters, PA with Insurance Fraud, Theft by Deception-False Impression
and Forgery. According to the complaint, it was alleged that Lehman filed multiple fraudulent injury claims on
behalf of herself and her live-in partner and in support of these claims, had provided forged and altered documents purportedly from West Shore Family Practice and Holy Spirit Hospital. The complaint states that
AFLAC and Humana Insurance Companies had paid the defendant some $5,465 combined in fraudulent
claims. [OTN: T6321350]
On March 17, 2015, from a referral received from the Office of Attorney General by Progressive Insurance
Company, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal Complaint in
Wyoming County charging 46 year-old Gary Michael Hackling of Tunkhannock, PA with two counts of Insurance Fraud. According to the complaint, on August 24, 2013 at approximately 11:05 AM, Hackling applied for
an auto insurance policy with Progressive Insurance and stated that he had not been in any accidents or received any traffic violations within the past five years. Hackling made a payment to Progressive at that time and
was insured. Hackling contacted Progressive on August 26, 2013 and submitted a claim reporting that he been
in an accident on August 24, 2013 at 11:30 AM. The investigation revealed that Hackling’s prior policy with
State Farm Insurance had been canceled on August 20, 2013, and that Hackling’s accident that he had reported to Progressive had actually occurred on August 24, 2013 at 8:35 AM, prior to his obtaining a policy with
Progressive. [OTN: T6324533]
On March 17, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Division
filed a Criminal Complaint charging 72 year-old William F. Barlow of Weatherly, PA with Insurance Fraud,
Criminal Attempt Theft by Deception-False Impression and Criminal Use of Communication Facility. According to the complaint, on February 16, 2011, a Liberty Mutual Insurance Company insured homeowner filed a
homeowners insurance claim for water damage on the living and dining room ceilings. Liberty Mutual paid the
homeowner $3,840.79 on the claim. The homeowner, according to the complaint, had hired Barlow, owner of
Federal Adjustment Services and reportedly signed an agreement with Barlow that Barlow would receive 35%
of any money gained through the claim. In April 2014, the homeowner again hired Barlow for an unrelated
matter on the exterior of his residence. Barlow, upon entering the home to speak about the home’s exterior
issue, reportedly noticed the damage to the ceiling in the living and dining room ceilings which the homeowner had not had repaired from the Liberty Mutual claim. Barlow, on April 26, 2014 on the homeowner’s behalf,
reportedly filed a claim for the same damages to the home’s living and dining room ceilings to USAA Insurance Company and subsequently faxed an estimate of $9,875 for the same damages. Further investigation
revealed that the photos taken by both Liberty Mutual and USAA in support of each claim showed identical
damage. USAA did not pay the claim. [OTN: T6327156]
On March 23, 2015, detectives of the Cumberland County District Attorney’s office filed a Criminal Complaint charging 41 year-old Nicole C. Chisholm of Lancaster, PA with two counts of Insurance Fraud and one
count of Theft by Deception-False Impression. According to the complaint, Chisolm reported to her insurer,
Erie Insurance Company, that while operating her 2005 Toyota Corolla on November 21, 2014, she swerved
to miss hitting a deer and hit a light pole on the property of her employer. Chisolm claimed that there was no
damage to the light pole and that there were no other passengers in her vehicle at the time of the crash; however, her vehicle was not drivable and Erie’s damage adjuster reportedly determined that the vehicle was a total
“The complaint states that
AFLAC and Humana
Insurance Companies had
paid the defendant some
$5,465 combined in
fraudulent claims.”
Page 12
Know the Risks, Know the Penalties
Fraud Stories (Continued)
loss. On December 11, 2014, an Erie Claims Facilitator reportedly received information that Chisolm had
actually been at work at the time of the crash and that another individual who was later found to be an excluded driver on the policy was driving the Corolla when the accident occurred. Further, Chisolm’s employer
had video surveillance footage of the defendant inside the building working at the time of the incident. On
December 23, 2014, investigators contacted the defendant and she, at that time, reportedly admitted that
someone listed as an excluded driver on her auto insurance policy was driving the Corolla when it crashed.
Erie had paid $8,583.24 to the lienholder of Chisolm’s Corolla, but upon learning that an excluded driver
had been operating the vehicle at the time of the crash, issued a stop payment. According to the complaint,
Chisolm is responsible for paying the estimated damages to the light pole in the amount of $5,552. [OTN:
T6345301]
On March 23, 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force assisted the Scranton City Police Department in the arrest of 29 year-old Kristina Sanchez of Pittston, PA. Sanchez was charged
“It was alleged that between
with Insurance Fraud and False Report Theft. According to the Criminal Complaint, on July 14, 2014,
Sanchez reported to Scranton Police Department that her 2006 Lincoln Zephyr had been stolen after she
October 1998 through
entered a convenience store. The complaint states that prior to Sanchez reporting the theft of the vehicle, the
August 2013, Spits had
vehicle had reportedly been involved in a crash and that the unidentified driver had fled the scene. According
to complaint, detectives subsequently viewed surveillance video footage of the convenience store’s parking lot
collected premiums for
active life insurance policies
in the amount of
$138,579.03, but failed to
remit the premiums to
and at no time is Sanchez seen entering the store nor is her vehicle seen parked where she claimed her vehicle
had been stolen from. It was alleged that Sanchez had been involved in an accident and that she fraudulently
reported to police and her insurer, USAA Insurance Company, that the vehicle had been stolen. [OTN:
T6354725]
On March 24. 2015, detectives of the Lehigh County District Attorney’s Insurance Fraud Unit filed a Criminal Complaint charging 46 year-old Elodia Reyna-Quintero of Staten Island, NY with Insurance Fraud. Ac-
Columbian Life Insurance
cording to the complaint, on August 26, 2014, Quintero was operating her 2003 Ford Focus and struck a
pedestrian. During the investigation, it was discovered that Quintero had purchased an auto insurance policy
Company.”
with Infinity Insurance Company, and at the time of application had given her primary mailing address and
garaging location as that of an Easton, PA; however, the investigation revealed that the defendant’s actual
address and garaging location of her vehicle was that of Staten Island, NY. [OTN: T634840]
On March 24, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 66 yearold Gregory Spitz of Aston, PA with Theft by Deception-False Impression and Theft by Failure to Make Required Disposition of Funds. According to the complaint, Spitz was an insurance agent with an active individual resident producer’s license with the Pennsylvania Insurance Department. It was alleged that between October 1998 through August 2013, Spitz had collected premiums for active life insurance policies in the
amount of $138,579.03, but failed to remit the premiums to Columbian Life Insurance Company. According to the complaint, Columbian Life was forced to pay out benefits on two death claims for two lapsed policies due to the misappropriation of premiums by Spitz, and that both of those policies had lapsed without the
knowledge or consent of the policy owner. [OTN: T6348311]
On March 25, 2015, from a referral received from State Farm Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 32 year-old Tatalea Chestnut of Philadelphia, PA and
charged her with Insurance Fraud and Forgery. According to the Criminal Complaint, it had been alleged
that Chestnut had utilized a fraudulent financial responsibility identification insurance card to register her
2000 Volvo on December 18, 2014. The complaint states that a representative of State Farm confirmed that
Know the Risks, Know the Penalties
11
Page 13
Fraud Stories (Continued)
the policy number on the bogus financial responsibility identification insurance card was not for a valid policy.
[OTN: N9562070]
On March 25, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint charging 31 year-old Alicia Colleen Kassakatis of Hanover, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on January 3, 2014, Kassakatis obtained an auto insurance
policy of GEICO Insurance Company to insure a 1998 Oldsmobile Cutlass. On February 3, 2014, the defendant filed a claim with GEICO alleging that she had been involved in a single-vehicle accident earlier in the day;
however, it was alleged that the damages to Kassakatis’ vehicle were the result of a crash the defendant had been
involved in on December 11, 2013, and that Kassakatis had not had a valid insurance policy when the December 2013 accident occurred. According to the complaint, on March 23, 2015, the defendant admitted that the
damages to her vehicle were not the result of a February 3, 2014 accident, and that she was attempting to obtain some $1,582.78 from GEICO to repair the damages from the December 2013 accident. GEICO did not
pay the claim. [OTN: T6358015]
On March 30, 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal
Complaint in Wayne County charging 36 year-old George Francis Kurz, III of Ozone Park, NY with Insurance
Fraud and two counts of Theft by Deception. According to the complaint, it was alleged that Kurz had defrauded Nationwide Property and Casualty Insurance Company of $13,905.90 by providing that the principal garaging address of his 2000 Chevy Suburban and 2013 Mercedes Benz was that of Lake Ariel, PA, when in fact,
Kurz’s primary address and garaging locations was that of Ozone Park, NY. The complaint states that Kurz
would have paid $22,249.20 in premiums had he foreclosed that his primary address was a New York address,
but had only paid $8,343.30 as he had been rated as a Pennsylvania resident. [OTN: T6368552]
On March 30, 2015, detectives of the Lehigh County District Attorney’s Insurance Fraud Unit filed a Criminal
Complaint charging 30 year-old Jeikenelys Lopez-Veguilla of Allentown, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, the defendant had reinstated her previously canceled Nationwide Insurance auto insurance policy after she had been involved in a motor vehicle
accident. It was alleged that Veguilla was driving her 2002 Honda Odyssey when she struck a Nissan Quest on
October 6, 2014 at 7:33 AM. Veguilla’s Nationwide auto insurance policy had canceled on September 12, 2014
due to non-payment, and Veguilla had not reinstated her policy until October 6, 2014 at 9:28 AM, approximately two hours after she was involved in the accident. Damages to the Nissan Quest that Veguilla struck were
$5,477.76. [OTN: T6370711]
On March 30, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Division
arrested 45 year-old Franklin Thomas Wilson of Middletown, DE and charged him with 8 counts of Insurance
Fraud, 14 counts of Conspiracy, 5 counts of Theft by Deception-False Impression, 3 counts of Criminal Mischief and Receiving Stolen Property, and 1 count each of Corrupt Organization and Criminal Attempt Theft by
Deception-False Impression. Wilson is the owner/operator of Transformers Collision Specialist, an auto body
shop in Delaware County. According to the complaint, it was alleged that the owners of damaged vehicles
would take their vehicles to Transformers Collision Specialist for repair and file claims to their insurers. Detectives reportedly received a tip from an unnamed individual in June 2011 who alleged that Wilson had been
committing insurance fraud by enhancing damages to vehicles brought into Transformers for repair in an effort
for him and willing customers to file more costly claims to their insurers. According to the complaint, victimized insurance companies included Progressive Insurance and Nationwide Insurance [OTN: T6325351] Co-
Body Shop
Owner Accused
of Enhancing
Damages;
Willing
Customers File
Inflated
Damage Claims
Know the Risks, Know the Penalties
Page 14
Fraud Stories (Continued)
defendants in the case who were alleged to have conspired with Wilson in filing fraudulent claims, also arrested on March 30, 2015, are as follows:
Auto Body
Shop
Customers
Charged for
Filing Inflated
Damage
Claims
·
Vernon Mockea White, 34, of Philadelphia, PA; charged with 3 counts of Conspiracy and 1 count
each of Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property, Unsworn
Falsification to Authorities and Criminal Use of Communication Facility; $13,757.70 fraudulent
claim to Progressive Insurance [OTN: T5573072]
·
Shakeya Nicole Miles, 32, of Cherry Hill, PA; charged with 3 counts of Conspiracy and 1 count
each of Insurance Fraud, Theft by Deception-False Impression and Receiving Stolen Property for
her alleged participation in White’s filing of fraudulent claim to Progressive Insurance Company
[OTN: T6325281]
·
Conchetta Edwards, 59, of Philadelphia, PA; charged with Conspiracy and Unsworn Falsification to
Authorities for her alleged participation in White’s filing of fraudulent claim to Progressive Insurance Company [OTN: T6325351]
·
Pamela A. Fields, 51, of Philadelphia, PA; charged with Conspiracy and Unsworn Falsification to
Authorities for her alleged participation in White’s filing of fraudulent claim to Progressive Insurance Company [OTN: T6325395]
·
Nicole Walton, 41, of Philadelphia, PA; charged with 3 counts of Conspiracy and 1 count each off
Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property and Unsworn
Falsification to Authorities for her alleged participation in White’s filing of fraudulent claim to
Progressive Insurance Company [OTN: T6325336]
·
Adiaha Bell, 32, of Philadelphia, PA; charged with 3 counts of Conspiracy and 1 count each of
Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property and Criminal Use
of Communication Facility; $9,920.84 in fraudulent claims to Progressive Insurance [OTN:
T6325826]
·
Ashley Christine Wilson, 26, of Darby, PA; charged with 3 counts of Conspiracy and 1 count each
of Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property and Criminal
Use of Communication Facility; $5,340.55 in fraudulent claims to Progressive Insurance [OTN:
T6325432]
·
Jamar L. Grant, 27, of Philadelphia, PA; charged with 3 counts of Conspiracy and 1 count each of
Insurance Fraud, Theft by Deception-False Impression, Receiving Stolen Property and Criminal Use
of Communication Facility; $6,321.88 fraudulent claim to Nationwide Insurance [OTN: T6325550]
·
Tywana S. Neal, 36, of King of Prussia, PA; charged with 2 counts of Criminal Attempt-Receiving
Stolen Property and 1 count each of Insurance Fraud, Conspiracy, Theft by Deception-False Impression, Receiving Stolen Property and Criminal Use of Communication Facility; $12,254.87 in fraudulent claims to Nationwide Insurance [OTN: T6325550]
·
Letisha Zenobia Johnson, 44, of Philadelphia, PA; charged with Insurance Fraud, Conspiracy, Criminal Attempt Theft by Deception-False Impression and Criminal Use of Communication Facility;
$12,181 fraudulent claim to Progressive Insurance [OTN: T6325502]
Know the Risks, Know the Penalties
Page 15
Fraud Stories (Continued)
On March 31, 2015, detectives of the Lehigh County District Attorney’s Insurance Fraud Unit filed a
Criminal Complaint charging 44 year-old Yvette Rodriguez of Bethlehem, PA with Insurance Fraud and
False Reports. According to the complaint, on July 18, 2014, Rodriguez reported to the Bethlehem Police Department that her mother had been operating her 2010 Nissan Maxima when the vehicle was
involved in a hit-and-run accident. The defendant subsequently reported the same and filed a claim with
her mother’s insurer, Infinity Insurance Company. Rodriguez, an unlicensed and uninsured driver,
reportedly later admitted that she had been operating the Maxima at the time of the accident. [OTN:
T6314151]
The Penalties:
The following dispositions of cases previously reported on were obtained via the web
portal of Pennsylvania’s Unified Judicial System.
On March 2, 2015, am Emmaus, PA woman was granted ARD with 12 months' probation and was ordered to
pay $1,936.25 in court costs. Insurance fraud detectives of the Lehigh County District Attorney’s office had
filed a Criminal Complaint in December 2014 charging the defendant with Insurance Fraud, Theft by Deception-False Impression and Accidents Involving Damage to Unattended Vehicle or Property. According to the
complaint, on November 9, 2014 at 1:42 AM, police officers responded to a hit-and-run accident involving a
red sedan which had struck two parked cars causing damage. The defendant reportedly, on November 10,
2014 at 9:51 AM filed a claim with State Farm Insurance Company stating that her red 2013 Chevrolet
Cruze sedan had been struck while parked at a friend’s house. On November 11, 2014, officers located the
“...it was revealed that the
defendant had actually
switched seats with
another individual who
was unlicensed and
defendant’s vehicle at Scott Collision Center in Allentown with damage that was consistent with having been
involved in the hit-and-run reported on November 9, 2014, and according to the complaint, on December 4,
driving the vehicle at the
2014 the defendant admitted that she’d been involved in the hit-and-run on the 9th. Damages to the defendant's vehicle were estimated to be $5,016.44, and $3,200 to the victims’ vehicles. [OTN: L9103091]
time of the accident.”
On March 2, 2015, an Emmaus, PA woman was granted ARD with 12 months’ probation and was ordered to
pay court costs totaling $1,939.25. Insurance fraud detectives of the Lehigh County District Attorney’s office
had filed a Criminal Complaint in December 2014 charging the defendant with Insurance Fraud and False
Reports. According to the complaint, on November 16, 2014, an employee of a Turkey Hill in Emmaus, PA
reported that a vehicle had been driven into the front of the building causing damage. Police officers responded to the incident, and the defendant reported that she had been driving the 2007 Chevrolet Cobalt when it
crashed into the front of the store, and subsequently filed a claim with Allstate Insurance Company reporting
the same. However, upon viewing video surveillance footage of the accident, it was revealed that the defendant had actually switched seats with another individual who was unlicensed and driving the vehicle at the time
of the accident. [OTN: L9105633]
On March 3, 2015, from a Guilty plea to Theft by Deception-False Impression, Thomas Edward Huth of
Hedgesville, PA was sentenced to serve nine months' probation and was ordered to pay a $750 fine and court
costs totaling $949. Office of Attorney General special agents had received a referral from Nationwide Insurance Company and filed two Criminal Complaints in June 2014 charging Huth and Preston Duane Miller of
Breezewood, PA with Insurance Fraud, Criminal Attempt Theft by Deception-False Impression and Conspiracy. The complaint reflects that in June 2013, Huth filed a claim with Nationwide stating that while he’d been
operating his 2003 Dodge Ram 2500 pickup truck, the truck sustained damages when a Nationwide insured
ran him off the road and into a creek bed. Nationwide paid Huth $4,524.25 for damages to the truck, and
Huth reportedly used the insurance money to purchase parts and make repairs to the truck himself. Huth
Page 16
Know the Risks, Know the Penalties
Fraud Stories (Continued)
subsequently claimed that the truck had electrical problems caused by the accident and was instructed by Nationwide to take the truck for diagnostic testing and provide Nationwide with an estimate for any repairs the
truck needed. Huth took the Dodge to Preston Miller’s Auto Body Shop in Breezewood, PA to obtain an
estimate. According to the complaint, Huth and Miller discussed providing false information to Nationwide
and Huth subsequently contacted Nationwide and falsely informed them that Miller had fixed the electrical
issues and that he’d paid Miller cash for the repairs. Both defendants allegedly submitted false receipts to
Nationwide reflecting that Huth paid cash for repairs in the amount of $4,525.94, and Miller further submitted a receipt for the purchase of parts from a business that didn’t exist. Reportedly, both defendants admitted
to Nationwide that no electrical repairs were made and that Huth never paid cash to Miller for repairs. Na-
“Both defendants allegedly
submitted false receipts to
tionwide had not paid the claim. Court records show the case against Miller remains active. [OTN: T4823136,
T4823195]
Nationwide reflecting that
On March 5, 2015, Ricky A. Vermillion of Smethport, PA pled Guilty to Criminal Attempt-Theft by Deception and was sentenced to serve a maximum of just under two years' probation and was ordered to perform 50
Huth paid cash for repairs
hours of community service and pay court costs totaling $1,099.25. On October 30, 2014, from a referral
in the amount of
$4,525.94, and Miller
received by special investigators of Progressive Insurance Company, Office of Attorney General special agents
had filed a Criminal Complaint charging Vermillion with Insurance Fraud and Criminal Attempt-Theft by
Deception. According to the complaint, on December 31, 2013, Vermillion added a 2000 Dodge Dakota to
further admitted to
his auto insurance policy with Progressive Insurance and subsequently filed a claim on January 14, 2014 stating that he’d struck a deer on January 9, 2014, and struck a barrier near a bridge after losing control of the
Nationwide that no
vehicle. Damages to the Dakota were estimated to be approximately $4,477.04; however, according to the
complaint, the investigation revealed that the defendant had recently purchased the vehicle with the majority
electrical repairs were made
if not all of the damages pre-existing. Progressive had not paid the claim. [OTN: T5830311]
and that Huth never paid
On March 6, 2015, a Dravosburg, PA man was granted ARD with 18 months' probation, was ordered to per-
cash to Miller for repairs.”
form 200 hours of community service and ordered to pay $599 in restitution, a $300 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs totaling $2,595. The Allegheny County District Attorney’s
office received the case for prosecution on November 25, 2014 from the Pittsburgh Police Department. Detectives of the Pittsburgh Police Department had arrested the defendant and charged him with Insurance Fraud
and False Reports to Law Enforcement. According to the Criminal Complaint, on July 3, 2014, officers responded to a stolen vehicle report at Presbyterian Hospital’s emergency room, where officers spoke to the
defendant’s girlfriend who reportedly stated that the defendant was so distraught over the theft of his truck
that he had punched a wall and suffered a broken hand. Detectives spoke to the defendant the following day
and he reportedly advised that his truck had only 11K miles and was in excellent condition. Detectives subsequently located the alleged stolen truck and found that it had been involved in an accident and towed on July
3, 2014. The truck was found with heavy front end damage. According to the complaint, the defendant later
reportedly admitted that after he and a friend had left a bar after consuming a few beers, he crashed the truck
and left it in a ditch, and subsequently falsely reported that it had been stolen. Erie Insurance had paid out
$299 for towing and storage of the vehicle. [OTN: G6966691]
On March 10, 2015, a Reading, PA woman was granted ARD with two years' probation and was ordered to
pay $268 in court costs. Office of Attorney General special agents arrested the defendant on December 18,
2014 and charged her with Insurance Fraud, Criminal Attempt Theft by Deception-False Impression and
Unsworn Falsification. According to the Criminal Complaint, the defendant filed a claim with Donegal Mutual Insurance Company on August 8, 2012, in which she included preexisting damage to her 2003 Lexus.
Know the Risks, Know the Penalties
Page 17
She allegedly told Donegal representatives that the Lexus had been vandalized and that the damage included
the vehicle’s passenger side mirror. The defendant subsequently completed and signed a Reading Police Department Crime Report form on which she also allegedly included the passenger side mirror in her description of the damage. According to the complaint, the report prominently displayed a warning above the defendant's signature which advised that in signing the form she was verifying the truth of her statements, subject to criminal penalties of Unsworn Falsification to Authorities. Further, the complaint stated that when
the assigned Donegal claim adjuster inspected the defendant's vehicle, he recalled having inspected the car
before, in conjunction with a prior claim. Donegal’s claim records allegedly included a copy of the adjuster’s
appraisal and photos of the Lexus which confirmed that the mirror damage was pre-existing. [OTN:
T6016533]
On March 16, 2015, Joseph F. Murray, Jr. of Williamstown, NJ pled Guilty to Penalty-Failure to Procure
Workers’ Compensation and was sentenced to serve 12 months' probation and was ordered to pay $3,709.18
in restitution and court costs of $916.50. Office of Attorney General special agents had arrested Murray in
November 2014, and charged him with Penalty-Failure to Procure Workers’ Compensation. According to
the Criminal Complaint, Murray owned and operated Joe’s Auto Transport, LLC in New Jersey, which did
business in Pennsylvania. The complaint states that on February 12, 2010, a company employee was injured
while at the Manheim Philadelphia Auto Auction. On August 10, 2010 the injured employee filed a workers’
compensation petition seeking payment for medical expenses he incurred as a result of his work-related injury. The complaint reflects that at the time of the employee’s injury, Joe’s Auto Transport, LLC did not have
workers’ compensation insurance. The Pennsylvania Uninsured Employer Guarantee Fund paid $3,709.18
in medical expenses of the injured employee. [OTN: T5875575]
On March 17, 2015, from a Negotiated Guilty plea to four counts of Manufacture, Delivery or Possession
With Intent to Deliver, Joseph Lundberg of Glenolden, PA was sentenced to serve 23 months' confinement
followed by two years' probation and was ordered to pay court costs of $3,733. Lundberg was charged on
January 12, 2015 with four counts each of Insurance Fraud, Possession of Controlled or Counterfeit Substance with Intent to Deliver and Possession of Controlled Substance. According to the Criminal Complaint, it is alleged that Lundberg utilized his Blue Cross Keystone First Insurance prescription plan to purchase various controlled substances to include Clonazepam and Suboxone and would then sell them for a
profit. The complaint reflects that Lundberg had sold controlled substances he had purchased by use of his
prescription plan to an undercover detective on several occasions. [OTN: T6093533]
On March 19, 2015, from a Negotiated Guilty plea to Insurance Fraud and Theft by Deception-False Impression, Douglas M. M. Rhedrick of Upper Darby, PA was sentenced to serve three years' probation and was
ordered to pay $3,000 in restitution and court costs totaling $435.50. Detectives of the Philadelphia District
Attorney’s Insurance Fraud Unit arrested Rhedrick in March 22, 2012 and charged him with Insurance
Fraud, Theft by Deception and Criminal Attempt/Theft by Deception. According to the Criminal Complaint, Rhedrick claimed he was a passenger on a Southeastern Pennsylvania Transportation Authority
(SEPTA) bus on May 19, 2010 when it was involved in a minor accident. Rhedrick claimed that he had
fallen into a pole and then onto the floor as a result of the impact of the accident. He subsequently sought
medical treatment at a hospital, where he was diagnosed with a bilateral nasal fracture and sought chiropractic care and surgery to repair his nasal fracture. Rhedrick obtained legal counsel to file a personal injury claim
against SEPTA on his behalf demanding some $150,000 to settle the claim. Surveillance video on the bus
had reportedly established that the accident was minor, and that Rhedrick’s claims were fraudulent as
Rhedrick was not disturbed at the time of the accident and had not been injured as he had claimed was the
result of the minor collision. [OTN: N7949863]
Probation for
Defendant
Who Filed
Fraudulent
$150K
Personal
Injury Claim
Against SEPTA
Page 18
Know the Risks, Know the Penalties
Fraud Stories (Continued)
On March 20, 2015, a Braddock, PA man was granted ARD with two years' probation, was ordered to perform
300 hours of community service and ordered to pay $5,243.38 in restitution, a $250 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs totaling $2,360. The defendant had been arrested in July
2013 by detectives of the Allegheny County District Attorney’s office and charged with 14 counts each of Insurance Fraud, Forgery and Theft by Deception. According to the complaint, the defendant's father passed away in
September 2011, and prior to his death, had been receiving workers' compensation disability wage loss payments of UPMC Health Plan. A UPMC investigator checking open compensation claims had discovered that
workers' compensation claim payments issued to the defendant's father had been cashed after the claimant was
deceased. It was alleged that the defendant continued to receive, forge and cash 14 UPMC workers' compensation payment checks totaling $5,243.38 after his father was deceased. [OTN: G5977580]
On March 23, 2015, Michelle L. D'Angelo of McDonald, PA pled Guilty to Conspiracy and was sentenced to
serve 12 months' probation and was ordered to pay a $250 fine and court costs of $1,350. In September 2014,
Office of Attorney General special agents filed three Criminal Complaints charging D’Angelo and Dianne E.
“It was alleged that the
defendant continued to
receive, forge and cash 14
UPMC workers’
compensation payment
checks totaling $5,243.38
after his father was
deceased.”
Cardillo also of McDonald, PA with two counts of Insurance Fraud and one count of Conspiracy. A Bridgeville,
PA woman, who was granted ARD with two years’ probation in February 2015 had been charged with two
counts of Insurance Fraud and one count each of Theft by Deception-False Impression and Conspiracy. According to the complaints, on June 18, 2012 a fire damaged the residence of Cardillo’s stepdaughter. The residence
was insured by Conemaugh Valley Mutual Insurance Company, which was later purchased by Allegany Co-Op
Insurance Company. Pursuant to her policy, Cardillo’s stepdaughter was entitled to reimbursement for food
and lodging for which she paid while her home was being repaired, and she submitted receipts for reimbursement to Allegany Co-Op for food she purchased at Hunner’s Deli totaling $387.85, and for $1,500.00 she paid
to Michelle D’Angelo for staying at her house. Investigation revealed that these receipts were fraudulent as Cardillo’s stepdaughter did not purchase food at Hunner’s Deli, nor did she pay $1500.00 to Michelle D’Angelo or
stay at her home. Cardillo reportedly created the bogus Hunner’s receipt and asked Michelle D’Angelo to prepare the fraudulent $1500.00 receipt. Upon receiving the receipts, Cardillo’s stepdaughter submitted them to
Allegany Co-Op and was paid. Dianne E. Cardillo was sentenced in February 2015 to serve two years' probation
and was ordered to pay a $1,000 fine and court costs totaling $1,950. [OTN: T5662930, T5662786, T5662451]
On March 24, 2015, an Audobon, NJ woman was granted ARD with 12 months' probation and was ordered to
pay $701 in restitution, a $500 civil penalty to the Insurance Fraud Prevention Trust Fund and court costs totaling $1,801.50. Office of Attorney General special agents had filed a Criminal Complaint in July 2013 charging
the defendant with two counts each of Insurance Fraud and Theft by Deception. According to the complaint,
the defendant had loaned her 2005 Hyundai Sonata, insured by GEICO Insurance, to another individual on
November 11, 2011 and the individual was involved in an accident with the Hyundai. Allegedly, after fleeing
the scene of the accident, the defendant’s friend offered to get rid of the Hyundai so that the defendant could
claim that her vehicle had been stolen. On November 12, 2011, the defendant submitted a theft claim to GEICO. The damaged vehicle, recovered weeks later by police, was declared a total loss by GEICO as the costs of
repairing the vehicle exceeded its estimated value of $5,848. GEICO’s claim investigation uncovered the hit-and
-run accident, after GEICO had paid out $701 for towing of the damaged vehicle, and GEICO denied payment
of the defendant’s $5,848 claim. [OTN: T3480853]
On March 25, 2015, from a Negotiated Guilty plea to Insurance Fraud, Robert Curtis Jackson of Philadelphia,
PA was sentenced to serve two years' probation and was ordered to pay a $500 fine and court costs totaling
$749. On January 5, 2015, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested
Know the Risks, Know the Penalties
Fraud Stories (Continued)
Jackson and charged him with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the Criminal Complaint, detectives had received a referral from the risk management department of
Save a Lot supermarkets. Jackson had reportedly stated that on April 2, 2014, he slipped on a puddle of water
while shopping inside the supermarket, and retained counsel to file a personal injury claim on his behalf
against Save a Lot for alleged injuries to his knee, back and hip. Jackson’s medical records were obtained by
detectives and showed that Jackson sought treatment on more than 50 occasions between April and August
2014. Surveillance footage from the supermarket was viewed by detectives and according to the complaint,
Jackson is seen spilling a bottle of water on to the floor, placing the bottle among other merchandise on a
nearby shelf, leaving the aisle where he had spilled the water and returning a few minutes later and lowering
himself on to the spilled water. Jackson’s medical bills were in excess of $18,000; however, no money was
paid by Save a Lot. [OTN: N9465595]
Page 19
Page 20
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*September 13-16, 2015 — IASIU 2015 Seminar & Expo on Insurance Fraud — JW Marriot,
Orlando, FL
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Who to Call
Page 21
Insurance Fraud
Allegheny County DA’s Office, (412) 461-2328
Allegheny County PD, (412) 473-1254
Attorney General’s Office, (717) 787-0272
Cumberland County DA’s Office, (717) 240-7764
PA INSURANCE FRAUD
PREVENTION
AUTHORITY
Delaware County DA’s Office, (610) 891-4700
Erie Bureau of Police, (814) 870-1258
Lehigh County DA’s Office, (610) 264-8758
6 Kacey Court, Ste. 101
Mechanicsburg, PA 17055
Montgomery County DA’s Office, (610) 278-3472
Phone: 717-691-1828
Philadelphia DA’s Office, (215) 686-8723
Fax: 717-697-1013
York County DA’s Office, (717) 771-9600 x 329
NE Insurance Fraud Task Force, (570) 963-5177
www.HelpStopFraud.Org
Arson
Dauphin County DA’s Office, (717) 255-2770
PA State Police-Fire Marshals, (717) 346-4597
Anti-Fraud Compliance
PA Insurance Department, (717) 705-4199
IFPA Staff
Thomas Donahue,
Executive Director, [email protected]
Joan Dockery,
Associate Executive Director, [email protected]
Christine Cassel,
Grants Administrator, [email protected]