Pennsylvania Fraud Stories
DECEMBER 2015
Pennsylvania
Insurance Fraud Prevention
Authority
Inside this issue:
Public Relations
2
Know the Risks!
3
Four Arrests in Staged
3
Accident
Langhorne, PA Busi-
Message from the Executive Director
Happy New Year, and welcome to the December edition of our monthly newsletter,
reporting November’s arrests and dispositions.
4
nessman Charged with
Congratulations to Assistant District Attorney, Linda Montag, of the Philadelphia
Insurance Fraud
District Attorney’s Office Insurance Fraud Unit! The Coalition Against Insurance
Insurance Fraud & Re-
5
lated Charges the Re-
gation and prosecution of insurance fraud with their 2015 Prosecutor of the Year
Award. The award was presented at the Coalition’s annual membership meeting near
sult of Altered Medical
Washington, DC. Linda was accompanied by Detectives Al Quintile and Robert
Bills Submitted to Aflac
Brothers Arrested After
Fraud recently honored the efforts of Ms. Montag for her role in a successful investi-
DiFrancesco.
6
Ralph Burnham
Thomas
Donahue
One Brother Allegedly
Linda Montag was instrumental in a grand jury investigation which resulted in 47 de-
Uses the Other’s United
fendants being charged for their involvement in a staged trip and fall accident scheme
Concordia Dental Insur-
that defrauded 21 insurance companies out of $400,000. Defendants included individuals who filed fraudulent
ance Card to Pay for
claims, “runners” who were paid to recruit them. Attorney and sole practitioner, Andrew Gaber, led and ran the
Several Dental Proce-
operation from his law office, and reportedly committed suicide before facing certain conviction.
dures
Parking Lot Scuffle
7
Executive
Director
IFPA
Executive
Director
Gaber had hired a small army of recruiters to recruit individuals he would pay to act as phony injury victims; many
Results in Charges of
of which were homeless or drug addicts. The “victims” were coached on how to stage a seemingly painful fall and
Insurance Fraud & Dis-
act injured, often pretending to trip on small cracks in neighborhood sidewalks, and recruiters acted as witnesses
orderly Conduct
and “injured” victims. Gaber then filed false injury claims against homeowner policies.
Disability Insurance
8
Fraud
Body Shop Owner &
The scam lasted seven years and bilked 21 insurance companies. Montag worked closely with investigators from
the Philadelphia District Attorney’s insurance fraud unit to build the case for a grand jury. The investigation took
9
two painstaking years, but the effort paid off. Some 47 ring members were charged. Gaber, his runners and fake
Client Conspire to Sub-
injury victims were included. Searches of bank transactions and Gaber’s files revealed crucial evidence. Secretly
mit Bogus/Altered Tow
recorded conversations by ring members and Gaber were highly incriminating. Insurers and the National Insur-
Invoice to Nationwide
ance Crime Bureau provided case referrals that proved vital to exposing the fraud ring’s inner workings.
Nearly $10K in Medical
10
Bill Reimbursement
Montag assembled more than 350 exhibits for the grand jury. Dozens of witnesses testified. Grants of immunity
gave many ring members an incentive to testify against other ring members. The case was so complete that Gaber
Denied After Alleged
committed suicide before his trial began. Most remaining ring members pleaded guilty instead of heading to con-
Fraud Revealed
Know the Penalties!
11
Mark Your Calendar!
17
Who to Call
18
viction and harsher sentences. Montag obtained $250,000 in restitution from Gaber’s law practice. Ring members
were ordered to pay an additional $60,815 and nearly $40,000 in penalties.
The Pennsylvania Fraud Conference will be held in Hershey, PA on Thursday, April 7th and Friday, April 8th.
The conference schedule is slightly different, with Thursday being a full day of networking and education followed
by a half day on Friday. Our group of presenters will make for another outstanding conference. Registration emails will be going out shortly.
Thank you for your continued efforts in combating insurance fraud in Pennsylvania! Have a Happy and Safe New
Year!
Page 2
Public Relations
Visit our website at www.helpstopfraud.org;
Be on the look-out for new billboards popping up
throughout Central Pennsylvania!
Weasy’s on Facebook at www.facebook.com/dontbeabut
Facebook at www.facebook.com/PennIFPA;
Rumor has it that Weasy’s been seen hanging out at Penn
State football games, and there are pictures to prove it!
and on YouTube!
Know the Risks, Know the Penalties
Page 3
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.
In November 2015, from a referral received from the National Insurance Crime Bureau (NICB) regarding
Repwest Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested four individuals, each of Philadelphia, PA. Derrick Stephens, 26, and Ameena Michaels, 23, were
each charged with Criminal Attempt Theft by Deception-False Impression, Conspiracy and False Reports.
Matenneh Kamara, 33, and Khalil Logan, 29, were each charged with Theft by Deception-False Impression,
Conspiracy and False Reports. According to the Criminal Complaints, on March 13, 2014, the defendants
claimed that they were involved in an accident between a Repwest insured UHaul truck and a USAA insured Nissan Quest. Insurance fraud detectives retrieved a Philadelphia Police Report that is completed by
complainants after an accident which indicated that Logan had crashed a UHaul rental vehicle into a 2004
Nissan Quest owned by Kamara and occupied by Kamara, Michaels and Stephens. Each occupant of the
Quest retained an attorney to represent them in a personal injury lawsuit stemming from the alleged accident and also sought physical therapy. However, all four defendants later admitted to a Repwest adjuster
that the accident had been staged for the purpose of filing fraudulent claims. [OTN: N9870582, N9864713,
N9866371, N9867992]
On November 2, 2015, from a referral received from the Delaware Department of Insurance Fraud, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 46 year-old Aadvon Pollitt of
New Castle, DE and charged him with Insurance Fraud, Theft by Deception and Violation Workers’ Compensation Act. According to the Criminal Complaint, in November 2013, Pollitt was injured while working
as a maintenance mechanic at Cushman and Wakefield. Pollitt subsequently stopped working and began
receiving workers’ compensation benefits through AIG Property Insurance, which totaled in excess of
$15,000 in medical bills and lost wages. However, according to the complaint, Pollitt began working two
weeks after his purported injury as a maintenance clerk at the Sheraton Suites Hotel performing identical
job duties and allegedly continued to receive workers’ compensation benefits while working full-time at the
Sheraton Suites Hotel. [OTN: N9850654]
On November 3, 2015, Office of Attorney General special agents filed a Criminal Complaint in Montgomery County charging 42 year-old Eli A. Latson of Philadelphia, PA with Insurance Fraud and Attempted
Theft by Deception-False Impression. According to the complaint, Latson’s wife, Angela Bridges, purchased
a vehicle insurance policy from Progressive Insurance, which covered the six-month period from July 12,
2013 through January 12, 2014. The policy listed Latson as a covered driver. On December 6, 2013, Latson
allegedly contacted Progressive Insurance and claimed that while he was at work, the insured vehicle was
struck while it was parked and unattended. Latson allegedly told Progressive that the collision had occurred
between 11:00 AM and 11:30 AM on December 6, 2013. According to the complaint, investigators determined that the vehicle’s damage did not appear to be consistent with the type of damage typically associated
with a hit-and-run. During a recorded interview with investigators, Latson admitted that he had loaned the
car to a friend, and that the vehicle was in his friend’s possession when the damage occurred. [OTN:
T7212623]
Philadelphia
DA’s Insurance
Fraud
Detectives
Arrest Four in
Alleged Staged
Accident
Page 4
Know the Risks, Know the Penalties
Fraud Stories (Continued)
On November 3, 2015, Office of Attorney General special agents filed a Criminal Complaint in Montgomery
County charging 26 year-old Danielle Michels of Levittown, PA with Insurance Fraud and Criminal Attempt
Theft by Deception-False Impression. According to the complaint, on May 2, 2013 at 10:21 AM, Michels’
contacted Progressive Insurance Company to report that she’d been involved in a motor vehicle accident on
May 1, 2013 at approximately 9:00 PM when her boyfriend was operating her vehicle and she was a passenger.
Further investigation revealed that Michels had purchased a Progressive auto insurance policy online on May
1, 2013 at 8:45 PM, and according to the complaint, an investigating police officer reported that the crash
had occurred on May 1, 2013 at 4:46 PM and that a tow company was dispatched to tow the vehicle at 5:01
PM that same day. According to the complaint, Progressive denied Michels’ claim as the investigation revealed
that Michels’ vehicle was uninsured at the time of the crash, and Michels allegedly misrepresented the time of
the crash when filing a claim with Progressive in order to receive coverage for the loss. [OTN: T7212704]
On November 4, 2015, detectives of the Bucks County District Attorney’s Office filed a Criminal Complaint
charging 42 year-old John Michael New of Langhorne, PA with five counts each of Receives Advance Payment
Langhorne, PA
Businessman
Charged with
Insurance
Fraud for Not
Disclosing
Prior Lawsuits
During
Application for
Edemnify
Insurance
Policy
for Services and Fails to Perform and Deceptive Business Practices, two counts of Theft by Unlawful Taking
and one count each of Theft by Deception-False Impression and Insurance Fraud. According to the complaint, New is the owner/operator of NUHL Construction & Management Group, LLC. New had previously
owned and operated John M. New General Contracting and JMN General Contractors. According to the
complaint, each company was checked for Pennsylvania Home Improvement Contractor’s registrations and
only NUHL was found to have been registered from December 17, 2012 through December 17, 2014, at
which time the registration expired. The complaint reflects that during New’s applying for insurance with
Edemnify Insurance Company to insure NUHL, New allegedly had not disclosed five lawsuits that had been
filed against him and his former company, JMN General Contractors, Inc. from May 2007 through May
2008. Edemnify terminated New’s policy on October 21, 2013 as New had not been forthcoming when asked
on Edemnify’s application with regard to prior lawsuits having been filed against him or any of his businesses.
[OTN: T7219166]
On November 4, 2015, Office of Attorney General special agents filed a Criminal Complaint in Washington
County charging 38 year-old Rene Daugherty of Washington, PA with Insurance Fraud and Theft by Deception-False Impression. On March 4, 2015, Daugherty contacted GEICO Insurance and asked for a lower
collision deductible on her vehicle policy. She also asked GEICO to increase her policy’s rental allowance. On
March 5th, according to the complaint, Daugherty contacted GEICO and claimed that her car was damaged
that day when it struck a brick pillar in a church parking lot. GEICO paid the claim. However, the complaint
stated that GEICO subsequently obtained security video from the church which revealed that the accident
actually took place on March 4, 2015 at approximately 10:13 PM, before Daugherty made changes to the
vehicle policy. [OTN: T7220452]
On November 5, 2015, Office of Attorney General special agents filed a Criminal Complaint in Fayette
County charging 32 year-old Jacqueline R. Cunningham of Perryopolis, PA with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on March 5, 2015, Cunningham
added comprehensive and collision coverage to her automobile policy with Progressive Insurance Company.
On March 11, 2015, Cunningham filed a claim in which she allegedly reported to Progressive that her husband was involved in an accident while driving the insured vehicle. However, according to the complaint, a
person claiming to be a relative of the husband contacted Progressive and reported that the accident actually
occurred on February 15, 2015, and that the vehicle has been at the relative’s property ever since. According
to the complaint, Cunningham admitted to investigators that she added coverage to the policy after the fact,
Know the Risks, Know the Penalties
Page 5
Fraud Stories (Continued)
and that she made misrepresentations to Progressive in hopes that the insurer would cover the loss. [OTN:
T7221955]
On November 10, 2015, Office of Attorney General special agents filed a Criminal Complaint in Armstrong
County charging 34 year-old Jessica R. Loughrey of Kittanning, PA with Insurance Fraud and Attempted Theft
by Deception-False Impression. According to the complaint, on June 5, 2015, Loughrey added comprehensive
and collision coverage to her Progressive Insurance automobile policy. At 1:31 PM, approximately five hours
after the coverage change took place, Loughrey allegedly contacted Progressive and reported that her vehicle had
struck a deer. Loughrey allegedly provided photographs of the damage to the insurer. According to the criminal
complaint, a Progressive representative conducted a social media search and found photographs of the damaged
vehicle posted to Loughrey’s Facebook account. The complaint stated that at 8:10 AM on June 5, 2015,
Loughrey uploaded copies of the same photos that she had submitted to Progressive on Facebook which contained a time stamped photo showing that the accident occurred at least twenty-three minutes before Loughrey
added comprehensive and collision coverage to her vehicle policy. Loughrey allegedly admitted to investigators
that she had misrepresented the time of the crash, in hopes of getting Progressive to cover the cost of a rental
car. [OTN: T7242421]
On November 11, 2015, detectives of the Allegheny County Police Department filed a Criminal Complaint
charging 30 year-old Jeffrey J. Kountz of Pittsburgh, PA with two counts of Insurance Fraud. According to the
complaint, it had been alleged that when Kountz applied for an auto insurance policy on June 3, 2015 at 8:20
PM with Safe Auto Insurance Company, he had not disclosed that he’d been involved in an auto accident at
approximately 6:44 PM that same day, prior to obtaining the policy. Kountz submitted a claim to Safe Auto and
reportedly stated that the accident occurred approximately 10 minutes after he’d obtained the Safe Auto policy;
however, Safe Auto had not paid Kountz’s claim after learning that Mt. Lebanon Police had responded to the
accident at 6:44 PM on June 3rd and a tow bill listed 6:50 PM as when the tow company received a call that
Kountz’s vehicle needed to be towed. [OTN: G7275343]
On November 12, 2015, Office of Attorney General special agents filed a Criminal Complaint in Erie County
charging 25 year-old Katelyn M. Wurst of Erie, PA with Insurance Fraud, Theft by Deception-False Impression
and Attempted Theft by Deception-False Impression. According to the complaint, Wurst had an accident policy
with Aflac Insurance which was designed to help pay for emergency medical treatment, as well as related transportation and lodging expenses. Between January 28, 2015, and February 24, 2015, Wurst allegedly submitted
nine claims to Aflac for chiropractic treatment that she purportedly received at Heritage Chiropractic. According
to the complaint, an investigation revealed that on seven of the claims, Wurst had photocopied legitimate chiropractic bills, but altered the dates of treatment and the description of services on the documents before sending
the bills to Aflac. Aflac paid a portion of the claims before discovering the alleged fraud. [OTN: T7245324]
On November 12, 2015, Office of Attorney General special agents filed a Criminal Complaint in Bucks County
charging 27 year-old Chrisandra Denna Trapp of Philadelphia, PA with two counts of Insurance Fraud and one
count of Criminal Attempt Theft by Deception-False Impression. According to the complaint, Trapp purchased
a GEICO Insurance auto insurance policy on September 13, 2013 at 9:15 PM to insure her 2007 Pontiac Grand
Prix. Subsequently on September 13, 2013 at 10:43 PM, Trapp contacted GEICO again to report that she had
been involved in an accident with a 2011 Ford Focus, insured with Nationwide Insurance, while operating her
Grand Prix with her fiancé as a passenger at 9:45 PM that same evening. GEICO reportedly obtained a Philadelphia Police Accident Report that stated the accident occurred on September 13 th at 7:45 PM, which was prior to
Trapp obtaining her GEICO auto insurance policy. The investigation revealed that, in addition to Trapp allegedly misrepresenting to GEICO the actual time of the crash, she had also fraudulently claimed that her fiancé was
“...an investigation
revealed that on seven of
the claims, Wurst had
photocopied legitimate
chiropractic bills, but
altered the dates of
treatment and the
description of services on
the documents before
sending the bills to
AFLAC.”
Page 6
Know the Risks, Know the Penalties
Fraud Stories (Continued)
in the vehicle at the time of the crash when in fact, she was the only occupant in her vehicle at the time.
Neither GEICO nor Nationwide paid any part of Trapp’s claim. [OTN: T7245066]
On November 12, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 29
year-old Daniel Nolan of Philadelphia, PA with Insurance Fraud and Attempted Theft by Deception-False
Impression. According to the complaint, Nolan allowed his Progressive auto insurance policy to lapse on his
1998 Oldsmobile Cutlass on January 22, 2013. On March 13, 2013 at 6:44 PM, Nolan contacted Progressive and obtained a new valid auto policy. On March 14, 2013, Nolan called Progressive to file a claim for a
motor vehicle accident that occurred the day before at 7:00 PM. According to the complaint, special agents
reviewed a Mount Laurel Police Department police report which reportedly stated that Nolan had been
driving his vehicle in New Jersey on March 13, 2013 at 5:59 PM when he became involved in an auto acci-
“According to the
complaint, David Boston
used Brandon’s
dent. On October 1, 2015, during an interview with special agents, Nolan reportedly admitted to making a
false claim when he misrepresented the time of the accident to reflect that it occurred after his new policy
had been activated. [OTN: N9863313]
On November 16, 2015, from a referral received from American Independent Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 25 year-old Stephanie Felder of
identification and United
Philadelphia, PA and charged her with Insurance Fraud and Forgery. According to the Criminal Complaint, Felder was involved in an accident when she hit a property and it was alleged that Felder provided
Concordia dental
the owner of the property with a fraudulent American Independent policy number. The complaint states
that when the property owner tried to file a claim with American Independent, the property owner was
insurance card to pay for
advised that American Independent did not insure Felder or her vehicle. [OTN: N9868471]
several procedures that
On November 17, 2015, detectives of the Allegheny County Police Department filed a Criminal Complaint
David received between
charging 23 year-old Danielle Lynn Pusateri of Pittsburgh, PA with two counts of Insurance Fraud. According to the complaint, Pusateri allegedly submitted an altered Forbes Hospital Emergency Room report to
April 2, 2013 and
Allstate Benefits/American Heritage Life Insurance Company under her group accidental injury policy.
Pusateri had completed an Allstate Benefits form on March 28, 2015 reportedly stating that she was eating
October 9, 2013.”
candy and broke a tooth, and in support of her claim, reportedly submitted an altered Emergency Room
report that stated she had visited the emergency room complaining of dental pain and further stated that
she had cavities in her lower molars. The report, however, did not state that Pusateri had broken a tooth
while eating candy. Pusateri’s claim was not paid. [OTN: G7279823]
On November 18, 2015, Office of Attorney General special agents filed two Criminal Complaints in Allegheny County charging 29 year-old David A. Boston and 28 year-old Brandon M. Boston, both of Pittsburgh, PA with Insurance Fraud, Theft by Deception and Conspiracy. According to the complaint, David
Boston used Brandon’s identification and United Concordia dental insurance card to pay for several procedures that David received between April 2, 2013 and October 9, 2013. The complaint stated that investigators compared dental records of the two brothers and confirmed that it was David Boston, not Brandon,
who obtained the procedures in question. Both brothers allegedly admitted to their knowledge and involvement in the scheme. [OTN: G7280921, G7280910]
On November 18, 2015, Office of Attorney General special agents arrested 32 year-old Lucas Das Gracas
De Paula and his company, JAP Construction, each of Philadelphia, PA and charged each with 588 counts
of Failure to Carry Workers’ Compensation Insurance and one count each of Insurance Fraud, Theft by
Deception and Forgery. According to the Criminal Complaints, De Paula obtained workers’ compensation
Know the Risks, Know the Penalties
Page 7
Fraud Stories (Continued)
insurance for his business, effective September 8, 2006, from the State Workers’ Insurance Fund (SWIF).
However, by misrepresenting the number of his employees, he obtained that coverage at a reduced premium
rate and, as a result, underpaid premiums by approximately $19,923.00. According to the complaint, De
Paula‘s policy was canceled by SWIF on July 31, 2007, for non-payment. Nevertheless, De Paula’s company
allegedly continued to operate without workers’ compensation insurance from July 31, 2007, through March
of 2009, despite the fact that Pennsylvania employers are required by law to maintain coverage. The complaint further stated that during this time period, De Paula obtained a lucrative construction subcontract by
allegedly presenting a forged certificate of workers’ compensation insurance to the general contractor.
[K9160325]
On November 18, 2015, detectives of the Bucks County District Attorney’s Office filed a Criminal Complaint charging 45 year-old Joseph John Tittel of Levittown, PA with Insurance Fraud, Criminal Attempt
Theft by Deception-False Impression, False Reports and Disorderly Conduct. According to the complaint,
Tittel had obtained an attorney to represent him in a personal injury claim submitted to Esurance Insurance
Company regarding an alleged incident on September 24, 2015 in which Tittel reported that as he was backing out of a parking spot, another vehicle almost struck his vehicle. Tittel stated that as he was attempting to
exit the parking lot, he pulled behind the vehicle that had almost hit his vehicle and that the driver of that
vehicle got out and started a physical altercation with Tittel. Tittel further alleged that the other driver then
kicked Tittel’s vehicle, got back into his car and backed into Tittel’s car multiple times. However, according to
the complaint, the other driver had reported that Tittel had “tapped” the rear of his vehicle at the exit and
when he exited his vehicle to discuss with Tittel why he had hit his vehicle, Tittel allegedly became physically
confrontational, and a physical altercation commenced. Video surveillance footage reportedly contradicted
Tittel’s version of the incident. At no time does the surveillance footage show the other driver’s vehicle back
into Tittel’s vehicle. According to the complaint, surveillance footage shows the other driver’s vehicle approaching and stopping at the parking lot’s exit followed by Tittel’s vehicle. The video shows the other driver
exiting his vehicle and approaching Tittel’s vehicle and moments later, the two are seen engaged in a physical
altercation. The other driver is observed getting up from the ground, entering his vehicle and driving away,
while the Tittel’s vehicle is seen moving forward and up onto a curb while Tittel is clearly seen standing outside of his vehicle. [OTN: T7273033]
On November 19, 2015, from a referral received from Safe Auto Insurance Company, Office of Attorney
General special agents filed two Criminal Complaints in Dauphin County against 19 year-old Chyanne Marie
Johnson and 42 year-old Dena Stoney, both of Harrisburg, PA. Johnson was charged with two counts of Insurance Fraud and one count each of Criminal Attempt Theft by Deception-False Impression and Conspiracy. Stoney was charged with two counts each of Insurance Fraud and Theft by Deception-False Impression.
According to the complaints, on August 1, 2015 at 2:14 PM, Johnson contacted Safe Auto to obtain an auto
insurance policy to insure her 1998 Nissan. Johnson, at 4:57 PM, reportedly used Stoney’s credit card for
payment and Johnson’s policy became effective at 5:01 PM on August 1, 2015. Johnson called Safe Auto on
August 2, 2015 at approximately 1:00 PM to report that her vehicle had been involved in an accident just 10
minutes prior. Safe Auto’s adjuster estimated the damage to Johnson’s Nissan to be $3,281.67. According to
the complaint, Safe Auto later obtained an accident report from Harrisburg Police reportedly stating that the
accident occurred on August 1, 2015 at 4:19 AM and Johnson’s claim was denied and Safe Auto rescinded
her policy. The complaint states that Johnson later admitted to lying to Safe Auto about the actual time of the
accident and further reportedly stated that Stoney had allowed her to use her credit card to pay for the new
Parking Lot
Scuffle Leads
to Insurance
Fraud &
Disorderly
Conduct
Charges for
Levittown, PA
Man
Know the Risks, Know the Penalties
Page 8
Fraud Stories (Continued)
policy and that she conspired with her to lie to Safe Auto while obtaining the policy and reporting the accident. [OTN: L9832104, L9832093]
On November 20, 2015, detectives of the York County District Attorney’s Office filed a Criminal Complaint
charging 26 year-old Marlene E. Young of York, PA with two counts of Insurance Fraud and one count of
Attempted Theft by Deception-False Impression. According to the complaint, on October 29, 2015, Safe Auto
Insurance Company was contacted by an individual who had reported that he’d been involved in a twovehicle crash with Young on October 28, 2015 prior to 8:00 AM. The complaint reflects that on October 28,
2015 between 9:14 AM and 12:37 PM, Young had made three phone calls to Safe Auto regarding the purchase of an auto insurance policy. During the application process, Young reportedly stated that she had not
been involved in any auto accidents and that her vehicle had not sustained any damage within the past three
years. However, two photographs of the crash scene that had been reported to Safe Auto on October 29, 2015
were obtained by Safe Auto investigators, and each photos’ metadata showed that each had been taken on
October 28, 2015 at approximately 7:54 AM, before Young purchased the Safe Auto policy. According to the
complaint, Young was interviewed by a Safe Auto claims adjuster and allegedly misrepresented the actual time
of the accident in an effort to have Safe Auto pay approximately $1,200 for damages caused to the other vehicle she reportedly struck. [OTN: T7283076]
On November 23, 2015, Office of Attorney General special agents filed a Criminal Complaint in Montgomery County charging 33 year-old David L. Malenfant of Bristol, PA with Insurance Fraud and Attempted Theft
by Deception-False Impression. According to the complaint, Malenfant purchased an auto insurance policy
Disability
Insurance
Fraud
with a policy period of November 11, 2013 to May 11, 2014, but the policy lapsed on May 11, 2014, due to
non-payment. On September 17, 2014, Malenfant, still driving without insurance, was involved in a collision.
Shortly thereafter, Malenfant called an insurance agent and stated that he had been involved in an accident
and needed to reinstate this policy. The agent told Malenfant that he could reinstate the policy, but that his
accident would not be covered. In response, Malenfant told the agent that he did not want to reinstate the
policy. Malenfant then called Progressive’s toll-free number and purchased a policy at 4:37 PM. Several days
later, Malenfant called Progressive Insurance to report the September 17th accident, and reportedly stated that
it occurred at 5:00 PM. However, telephone records of the driver of the other car involved in the accident and
email records of that other driver’s employer establish that the accident occurred shortly before 4:05 PM. Bristol Police Department records also confirm that the accident occurred before Malenfant obtained insurance.
[OTN: T7290883]
On November 23, 2015, Office of Attorney General special agents filed a Criminal Complaint in Clearfield
County charging 46 year-old Shelby J. Shick of Burnside, PA with Insurance Fraud, Theft by Deception-False
Impression, Forgery and Attempted Theft by Deception-False Impression. According to the complaint, on
January 15, 2011, Shick applied for disability insurance coverage with Central States Health and Life Company of Omaha (CSO). The coverage was obtained in conjunction with a vehicle she purchased at a local car
dealership for in the event that Schick became disabled and was unable to work. CSO would pay the monthly
car payment to the vehicle loan company in the event of a disability. According to the complaint, on March 6,
2014, Shick filed a disability claim with CSO stating that she was unable to work after fracturing her foot.
CSO approved the claim and began making monthly car payments to Shick’s car loan company based on her
total disability. The total amount in loan payments paid by CSO from February 2014 to September 2014 was
$1,568.91. During this time, the complaint states that Shick submitted two continuing total disability claim
forms purportedly signed by physicians stating that Shick was unable to work based on her disability. The
Know the Risks, Know the Penalties
Page 9
Fraud Stories (Continued)
investigation revealed that Shick had returned to work and the disability claim forms submitted in support of
her continuing disability claim had allegedly been forged. The physicians that purportedly signed the Policy
Owner Progress Report forms for Shick had confirmed that they did not fill out the forms, nor is it their
signature on the forms. Schick’s employer provided employee records that show Schick had returned to work
on April 21, 2014, went out again on May 20, 2014, and returned to work on August 4, 2014. A claim overpayment of $627.56 was made by CSO based on the fraudulent Policy Owner Progress Report forms submitted by Schick. Reportedly, Shick also submitted a progress report to CSO in November 2014 stating that she
was to be released to work in January 2015. In the absence of CSO learning that the Shick had returned to
work in August 2014 and the progress report not being completed by a physician, benefits in the amount of
$784.41 would have been approved by CSO. Shick subsequently admitted that she submitted fraudulent
progress reports so that CSO would continue to make her car payments after she had returned to work.
[OTN: T7292283]
On November 23 & 24, 2015, from a referral received from Nationwide Insurance Company, detectives of
the Philadelphia District Attorney’s Insurance Fraud Unit arrested 30 year-old Erie Maratea and 47 year-old
Benjamin Ferrara of Philadelphia, PA. Maratea was charged with Criminal Attempt Theft by Deception-False
Impression and Conspiracy; Ferrara with Insurance Fraud, Criminal Attempt Theft by Deception-False Impression and Conspiracy. According to the Criminal Complaints, on January 9, 2015, Maratea contacted
Nationwide to file a claim stating that his 2008 Mercedes Benz had been vandalized while he’d been out with
a friend for the evening. Maratea claimed that multiple panels of the vehicle and the headlights and taillights
had all been scratched and the tire rims had been stolen. Detectives retrieved the claim file from Nationwide
that included a tow bill totaling $185 that Ferrara, owner of an auto body shop where Maratea’s vehicle was
towed, provided to the insurance company. According to the complaint, detectives interviewed the owner of
the towing company listed on the tow bill, and he had reportedly advised detectives that the invoice was
fraudulent. Ferrara during an interview with detectives subsequently admitted that he had manipulated the
invoice for Maratea to submit to Nationwide in support of his claim. [OTN: N9877604, N9878492]
On November 24, 2015, detectives of the Lehigh County District Attorney’s Office filed a Criminal Complaint charging 46 year-old Walter Ricardo Delarosa of Phillipsburg, NJ with Insurance Fraud. According to
the complaint, it had been alleged that Ricardo, while applying for an auto insurance policy with National
Liability and Fire Insurance Company to insure his 1998 Chevrolet S10, stated that his primary address was
of Reading, PA when in fact, his actual address is that of Phillipsburg, NJ. The complaint reflects that had
Ricardo been forthcoming as to his New Jersey address on the application for insurance, he’d have paid higher premiums. [OTN: T7294140]
On November 25, 2015, detectives of the Lehigh County District Attorney’s Office filed a Criminal Complaint charging 33 year-old Felicita Baez of Tobyhanna, PA with Insurance Fraud. According to the complaint, on April 10, 2014 at 12:40 PM, after renting a 2014 Dodge Dart, Baez struck an object and sustained a
flat tire, left the roadway and came to a stop in the median. The Dodge was towed at 2:08 PM. At 3:17 PM,
Baez contacted Progressive Insurance to reinstate her auto insurance policy which had reportedly expired on
March 20, 2014. The complaint states that Baez, in filing a claim with Progressive, misrepresented the actual
time of the accident to reflect that the accident occurred after she had reinstated her expired policy. [OTN:
L9845334]
On November 30, 2015, Office of Attorney General special agents filed two Criminal Complaints in Washington County charging 39 year-old Matthew S. Hartford and 44 year-old Michelle E. White, both of Charle-
Body Shop
Owner
Manipulates
Tow Invoice for
Client to
Submit to
Nationwide in
Support of
Claim
Page 10
Know the Risks, Know the Penalties
Fraud Stories (Continued)
roi, PA with two counts of Insurance Fraud and one count of Attempted Theft by Deception-False Impression. According to the complaints, on February 4, 2015, Hartford and White reported to GEICO Insurance
that on January 31, 2015, Hartford was backing up his 2014 Chevrolet Sonic and White was a passenger
when Hartford struck a pedestrian who was walking behind Hartford’s vehicle in an attempt to cross the
street. The pedestrian had filed a bodily injury claim with GEICO as a result of her injuries sustained in the
accident. Hartford’s GEICO policy had a single person bodily injury exposure limit of $15,000. An investigation into the pedestrian accident revealed that White, an unlicensed non-driver under Hartford’s policy with
GEICO was actually operating the insured vehicle at the time. The local police were called to the scene and
White identified herself to police as the operator of Hartford’s car. The pedestrian and an eyewitness also
identified White as the driver and lone occupant of Hartford’s car. GEICO would not cover any accident in
which White would be involved as the operator of Hartford’s vehicle. Hartford and White later acknowledged
during the investigation that they agreed to lie to GEICO in an effort to have the accident/bodily injury claim
“Progressive received
covered under Hartford’s insurance policy with GEICO. [OTN: T7307985, T7308081]
medical bills in the amount
On November 30, 2015, from a referral received from Progressive Insurance Company, Office of Attorney
General special agents filed a Criminal Complaint in Luzerne County charging 45 year-old Martin Carroll of
of $9,168 for the medical
Wilkes Barre, PA with Insurance Fraud, Attempted Theft by Deception-False Impression and Theft of Services. According to the complaint, On November 27, 2013, at 2:11 AM, John Carroll (Martin Carroll’s broth-
card that Martin Carroll
er), was operating a PT Cruiser registered to Christie Carroll (Martin Carroll’s wife), when he was involved in
an accident. The PA State Police handled the accident report and reported that John Carrol was the driver,
received at the ER.”
and that there were no passengers in the vehicle. At 4:23 AM, Martin Carroll called Progressive Insurance and
reported that he had been involved in a motor vehicle accident in the PT Cruiser. He stated that he was a
passenger in his wife’s PT cruiser, which was being driven by his brother, John Carroll, at the time. Martin
Carroll was listed as a driver under his wife’s policy. The policy listed the PT Cruiser as well. As a result of
Martin Carroll’s claim, an accident claim number was assigned to the case. On December 5, 2013, Martin
Carroll went to Wilkes-Barre General Hospital ER and reported that he had lower back pain from an accident
that had occurred on November 27, 2013. He provided the hospital with the Progressive accident claim number. Progressive received medical bills in the amount of $9,168 for the medical care that Martin Carroll received at the ER. On January 7, 2014, Martin Carrol went to MedExpress in Edwardsville, PA. He reported
that he was experiencing twitching and lower back pain from a motor vehicle accident on November 27, 2013.
Once again he provided the accident claim number he had received from Progressive. Progressive received
medical bills in the amount of $798.00 for the medical care he received at MedExpress. On September 3,
2015, special agents interviewed Martin Carroll, at which time he reportedly admitted that he had not been in
the vehicle at the time of the accident, and that he lied because he thought his brother did not have a valid
driver’s license. John Carroll did possess a valid driver’s license at the time of the accident. The complaint
reflects that Progressive did pay for the damage to the PT Cruiser, but that the request for medical bill reimbursement had been denied. [OTN: T7306865]
Know the Risks, Know the Penalties
The Penalties:
Page11
9
Page
The following dispositions of cases previously reported on were obtained via
the web portal of Pennsylvania’s Unified Judicial System.
On November 2, 2015, Yvette Rodriguez of Bethlehem, PA pled Guilty to Insurance Fraud and was sentenced
to serve three months' probation and was ordered to pay court costs totaling $802.50. On March 31, 2015,
detectives of the Lehigh County District Attorney's Office filed a Criminal Complaint Rodriguez with two
counts of Insurance Fraud and one count of False Reports. According to the complaint, on July 18, 2014, the
defendant reported to Bethlehem Police Department that her mother was driving a 2010 Nissan Maxima,
which was registered to her mother, while involved in a hit-and-run accident. Rodriguez, on that same date,
reported the accident and filed a claim to her mother's Infinity Insurance Company auto insurance policy.
According to the complaint, the defendant later admitted that she had actually been driving her mother's
vehicle at the time of the accident and that she did not have a valid driver's license nor was she a listed driver
on her mother's auto insurance policy. [OTN: T6314151]
On November 2, 2015, Seth A. Propheter of Corry, PA pled Guilty to Insurance Fraud and was sentenced to
serve 18 months' probation and was ordered to pay $250 in fines and court costs of $347.50. On March 5,
2015, Office of Attorney General special agents filed a Criminal Complaint charging Propheter 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 November 2, 2015, a Clearfield, PA man was granted ARD with two years' probation and was ordered to
perform 50 hours of community service and pay $1,990 in court costs. On June 22, 2015, Office of Attorney
General special agents filed a Criminal Complaint charging the defendant with Insurance Fraud and Criminal
Attempt Theft by Deception-False Impression. According to the complaint, on August 19, 2014 at approximately 8:00 PM, the defendant obtained an auto insurance policy with USAA Insurance Company. Subsequently, on August 20, 2014, the defendant filed a claim with USAA reporting that he rear ended another
vehicle on August 20, 2014; however, the driver of the other vehicle involved in the incident stated that the
accident had actually occurred on August 19, 2014 at approximately 3:30 PM and a Lawrence Township Police Report reportedly confirmed that the accident had not occurred on the 20th as the defendant had
claimed but had actually occurred on the 19th – prior to the defendant obtaining the USAA auto insurance
policy. [OTN: T6676692]
On November 3, 2015, a Lancaster, PA woman and the home healthcare franchise in which she was the Director/Operator were each granted ARD with two years' probation. The defendant was ordered to pay restitution of $2,521.86 and court costs totaling $2,517, and the healthcare franchise was ordered to pay restitution
of $2,521.86 and court costs totaling $2,487. On September 18, 2014, Office of Attorney General special
agents filed a Criminal Complaint charging the defendant and the home healthcare franchise each with two
counts of Insurance Fraud and one count each of Conspiracy and Theft by Deception-False Impression. According to the complaint, the defendant allegedly overbilled Pinnacle Health for home health care and mileage. The investigation revealed that the defendant instructed caregivers, working for the company, to overbill
for hours worked and mileage. An employee of Pinnacle Health reportedly discovered this overbilling scheme
Healthcare
Franchise
Director
Granted ARD &
Ordered to Pay
Restitution &
Court Costs
Totaling Over
$5,000
Page 12
Know the Risks, Know the Penalties
Fraud Stories (Continued)
when his wife was receiving care from an employee of the home healthcare company. He reportedly compared
the time cards submitted to the defendant by one of the company's caregivers and compared them to what the
defendant billed Pinnacle Health. According to the complaint, as a result of this overbilling scheme, the defendant had collected $2,526.86 from Pinnacle Health to which she was not entitled. The investigation revealed that the defendant was a high managerial employee with the company and was responsible for hiring,
firing, scheduling, dealing with clients and billing. [OTN: T5668515, T5668681]
On November 5, 2015, Robert M. Richards, Jr. of Mercer, PA pled Guilty to Criminal Attempt Theft by
Deception-False Impression and was sentenced to serve 18 months' probation and was ordered to perform
100 hours of community service and pay court costs of $466.50. On February 18, 2015, Office of Attorney
General special agents filed a Criminal Complaint charging Richards with Workers’ Compensation Insurance
Fraud and Criminal Attempt Theft by Deception-False Impression. According to the complaint, Richards was
employed as a tire technician at Grove City Tire for Less and on January 14, 2014, reported to his employer
“The complaint reflects that
that he had injured his back on January 11, 2014 while changing a tire. Richards subsequently sought medical
treatment at a local hospital. During the course of the investigation, special agents interviewed several of Rich-
Richards later applied for
ards’ co-workers who reportedly revealed that Richards had not mentioned any pain, injury or discomfort
welfare after his workers’
while working on the 11th; in fact, co-workers reported that Richards was getting in and out of cars and
changing tires without any noticeable physical problems or restrictions. According to the complaint, the inves-
compensation claim had
tigation revealed that Richards had allegedly injured his back while lifting a stroller at his home. Richards
later admitted that he had gone to the emergency room because of the pain he felt after moving a stroller at
been denied by Nationwide
Insurance Company, and
Medicaid paid $7,273.85 of
his medical bills.”
his home; not due to an injury he received at work, and further stated that he had not been honest as to how
he injured his back initially as he only wanted his medical bills paid. The complaint reflects that Richards
later applied for welfare after his workers’ compensation claim had been denied by Nationwide Insurance
Company, and Medicaid paid $7,273.85 of his medical bills. [OTN: T6228316]
On November 6, 2015, two Allentown, PA women were each granted ARD with six months' probation and
each was ordered to pay court costs of $1,639.25. On August 27, 2015, detectives of the Lehigh County District Attorney’s office filed two Criminal Complaints charging both defendants with Insurance Fraud and
Conspiracy. According to the complaints, it had been alleged that on January 8, 2015, the defendants, in
filing a claim with Titan (Nationwide) Insurance Company, had not been forthcoming as to who had been
operating a 2002 Honda Odyssey when it was involved in a motor vehicle accident. The investigation revealed
that the defendant that was driving the vehicle at the time of the accident was not a listed driver on the other
defendant’s auto insurance policy, and that the two defendants conspired in reporting that the insured defendant was operating the vehicle at the time of the crash. [OTN: L9647735, L9647676]
On November 9, 2015, a Gap, PA man was granted ARD with two years' probation and was ordered to perform 25 hours of community service and pay $2,518 in court costs. On June 23, 2015, Office of Attorney
General special agents filed a Criminal Complaint in Lancaster County charging the defendant with Insurance Fraud and Criminal Attempt Theft by Deception-False Impression. According to the complaint, it was
alleged that the defendant created a fraudulent purchase invoice in conjunction with a claim for the theft of a
stone roller which belonged to the paving business operated by him and his wife. The document was reportedly faxed to the Main Street America Group on December 28, 2012, and stated that the 2006 stone roller was
purchased from Key Equipment Sales and Rental in the amount of $12,500. Investigators, however, obtained
a copy of the actual sales invoice which state that the defendant paid only $3,975 for the stone roller. According to the complaint, the defendant admitted to creating the invoice after his insurance agent allegedly told
Know the Risks, Know the Penalties
11
Page 13
Fraud Stories (Continued)
him to claim the full replacement value of the roller, which the defendant's agent reportedly denied. Main
Street America Group did not pay the claim. [OTN: T6682550]
On November 9, 2015, a Hookstown, PA woman was granted ARD with six months' probation and was ordered to pay $1,615 in court costs. On June 16, 2015, Office of Attorney General special agents filed a Criminal Complaint in Beaver County charging the defendant with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on December 30, 2014 at approximately 6:04 PM, the defendant obtained a new auto insurance policy with Progressive Insurance Company that included comprehensive and collision coverage. The complaint reflects that the coverage was added at 6:07 PM. Subsequently, that
same evening, the defendant submitted a claim and stated that she had been involved in an accident between
7:00-7:30 PM, allegedly after she had obtained the Progressive policy. However, according to the complaint, a
Raccoon Township Police accident report showed that police were dispatched to the accident scene at 6:06 PM.
It was alleged that the defendant, in reporting the accident to Progressive, misrepresented the actual time of the
accident by stating it occurred after she had obtained the full coverage policy. Progressive did not pay the defendant's claim. [OTN: T6654141]
On November 9, 2015, Joseph Donald Leckemby of Uniontown, PA pled Guilty to Acquire or Obtain Possession of Controlled Substances and was sentenced to serve 30 months' confinement and was ordered to pay
$500 in fines, $55.28 in restitution and court costs totaling $1,044.25. On December 17, 2014, Office of Attorney General special agents arrested Leckemby and charged him with Insurance Fraud, Acquire or Obtain Possession of Controlled Substances and three counts of Forgery. According to the Criminal Complaint, between
March 2013 and December 2013, Leckemby presented four unauthorized prescriptions for Oxycodone at local
pharmacies. Leckemby allegedly altered otherwise legitimate prescriptions to make it appear that the scripts
were written for Oxycodone. Leckemby allegedly used his United Healthcare Insurance to pay for two of the
prescriptions. [OTN: T6008015]
On November 9, 2015, from a Negotiated Guilty plea to Insurance Fraud, Rasheen J. Brown of Philadelphia,
PA was sentenced to serve three years' probation and was ordered to pay $749 in court costs. On October 14,
2015, from a Negotiated Guilty plea to Insurance Fraud, Brown’s co-defendant, Anthony J. Daye of Philadelphia, PA was sentenced to serve two years' probation and was ordered to pay $1,500 in fines and court costs of
$749. On July 2, 2015, from a referral received from Sentry Insurance Company, detectives of the Philadelphia
District Attorney’s Insurance Fraud Unit arrested Brown and Daye. Brown was charged with two counts each of
Insurance Fraud, Theft by Deception and Conspiracy and one count of False Reports. Daye was charged with
Insurance Fraud, Attempted Theft by Deception, Conspiracy and False Reports. Also arrested on July 9, 2015
was Raheem Geathers of Philadelphia, PA. Geathers was charged with Insurance Fraud, Theft by Deception
and Criminal Conspiracy. According to the Criminal Complaints, on May 8, 2014, Brown was leaving a car
dealership, insured by Sentry Insurance Company, when he had a slight accident with another customer. An
Allstate Insurance insured woman was test driving a Chrysler Town and Country, which was owned by the
dealership, when she reversed into Brown’s Dodge Charger. According to the complaints, Brown and a female
were occupying the Charger at the time of the collision; however, detectives retrieved the Allstate claim file
which included a recorded statement given by Brown in which he stated that he had two males with him in the
car, identified as Daye and Geathers. The file also contained a statement from Daye stating that he was present
in the Dodge Charger when it was struck by the Town and Country. The complaints reflect that both Daye and
Geathers claimed injuries as a result of the accident to Sentry and Allstate. Detectives interviewed the woman
who was driving the Town and Country and she reportedly stated that she did slightly tap Brown’s Charger, but
that he and a female were the only passengers present in the car at the time of the accident. She further report-
Uniontown, PA
Man Pleads
Guilty in
Prescription
Fraud Case;
Sentenced to
30 Months’
Confinement
Page 14
Know the Risks, Know the Penalties
Fraud Stories (Continued)
edly stated that Brown appeared to be unscathed from the accident and denied that he ever lost consciousness
as Brown had reported to both Sentry and Allstate. Furthermore, employees of the car dealership also corroborated that Brown only had a woman accompanying him on the day of the accident. The complaints reflect
that during the course of this investigation, detectives learned that Brown allegedly filed a second false personal injury claim with Farmers Insurance Company when his unoccupied Charger was lightly struck by another
vehicle in October 2013. The driver of the striking vehicle stated that she did not know that her car was still
in reverse when she hit the gas pedal and struck Brown’s Dodge Charger. Brown had reportedly filed a personal injury claim in which he stated that he and another passenger were injured as a result of this collision as
well. Court records reflect that a preliminary hearing for Geathers is scheduled for February 12, 2016. [OTN:
N9695921, N9695932, N9704671]
On November 10, 2015, from a Negotiated Guilty plea to Theft by Deception-False Impression, Dennis Gerle
of Sewickley, PA was sentenced to serve three months' confinement with concurrent two years' probation and
was ordered to perform 50 hours of community service and pay $10,567.46 in restitution and court costs of
$2,072.50. On February 11, 2015, Office of Attorney General special agents filed a Criminal Complaint
charging Gerle with Insurance Fraud, Theft by Deception and False Reports to Law Enforcement. According
to the complaint, on September 29, 2013, Gerle reported to Sewickley Police Department and his insurer,
Defendants
Sentenced to
Jail Time
USAA Insurance Company, that his 2009 Chevrolet Equinox containing his wallet and driver’s license had
been stolen. Gerle was reportedly contacted just three days prior and had learned that the Equinox was to be
repossessed. The complaint reflects that Gerle was paid $3,131.50 for his equity in the vehicle, $890 for a
rental vehicle, and USAA had paid the balance of $12,431.16 to the lien holder of the Equinox. The vehicle
was later recovered in April 2014 parked across the street from where Gerle had reported the vehicle stolen.
The complaint states that a check of PennDOT records revealed that there were no duplicate driver’s license
for Gerle, which contradicts Gerle’s claim that his original license was stolen with the vehicle. Gerle subsequently admitted to filing a false theft report and claim. [OTN: G7029212]
On November 16, 2015, from a Negotiated Guilty plea to Insurance Fraud and Forgery, Talalea Chestnut of
Philadelphia, PA was sentenced to serve 23 months' confinement followed by 12 months' probation and was
ordered to pay $200 in restitution and $749 in court costs. On March 25, 2015, from a referral received from
State Farm Insurance Company, detectives of the Philadelphia District Attorney’s Insurance Fraud Unit
arrested Tatalea 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 the policy number on the bogus financial responsibility identification insurance card was not
for a valid policy. [OTN: N9562070]
On November 16, 2015, from a Negotiated Guilty plea to Insurance Fraud, Joseph B. Hoffman of Chester,
PA was sentenced to serve 23 months' in an Intermediate Punishment Program and was ordered to pay restitution totaling $6,354. On May 11, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Division had filed a Criminal Complaint charging Hoffman with Insurance Fraud, Theft by Deception-False Impression and Criminal Use of Communication Facility. According to the complaint, Hoffman
claimed he had been injured while a passenger on a SEPTA bus that made minor contact with a 2002 Saturn,
and subsequently sought medical treatment at Crozer Medical Center for alleged injuries to his left hip and
back. Detectives reviewed the bus’ video surveillance footage during the time of the minor collision which
reportedly shows that Hoffman had not been disturbed by the collision and shows Hoffman exiting the bus
without assistance, without being injured as he had claimed. The complaint states that Nationwide Insurance
had paid $6,354 in medical bills of Hoffman. [OTN: T6526214]
Know the Risks, Know the Penalties
Page 15
Fraud Stories (Continued)
On November 18, 2015, from a Negotiated Guilty plea to Insurance Fraud, Joseph E. Hinton of Philadelphia,
PA was sentenced to serve 18 months' probation and was ordered to pay a $500 civil penalty and court costs
of $749. On June 29, 2015, from a referral received from the Southeastern Pennsylvania Transit Authority
(SEPTA), detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested Hinton and
charged him with Insurance Fraud and Attempted Theft by Deception. According to the complaint, on September 30, 2013, a SEPTA bus was involved in an accident when it reportedly made minor contact with a
2007 Honda Accord and broke the sedan’s left side mirror. Hinton allegedly claimed that he had been a passenger on the bus at the time of the collision and that he had sustained injuries to his back, neck and shoulders. Hinton obtained counsel to file a personal injury claim on his behalf for medical bills he claimed to have
incurred in excess of $8,000. Reportedly, however, digital surveillance footage from the SEPTA bus showed
that Hinton was not present on the bus at the time of the minor collision and therefore had not been injured
as he had claimed. In fact, Hinton is seen approximately 15 minutes after the collision occurred boarding the
bus and proceeding to talk to passengers in the back of the bus who were present when the accident occurred.
[OTN: N9691975]
On November 18, 2015, a Philadelphia, PA man was granted ARD with 12 months' probation and was ordered to perform 32 hours of community service, pay $6,321.88 in restitution and court costs of $1,350. Detectives of the Delaware County District Attorney’s Criminal Investigation Division arrested the defendant in
March 2015 and charged him with three counts of Conspiracy and one count each of Insurance Fraud, Theft
by Deception-False Impression, Receiving Stolen Property and Criminal Use of Communication Facility. It
had been alleged that the defendant had conspired and participated with the owner/operator of Transformers
Collision Specialist, an auto body shop in Delaware County, in filing a fraudulent claim to Nationwide Insurance. According to the Criminal Complaint, the defendant had taken his damaged vehicle to Transformers
Collision Specialist for repair, at which time the owner/operator of the auto body shop allegedly enhanced
the vehicle’s damage in an effort to file a more costly claim with Nationwide. The defendant’s fraudulent
claim reportedly totaled $6,321.88. [OTN: T6325550]
On November 19, 2015, a Phillipsburg, PA man was granted ARD with six months' probation and was ordered to pay court costs of $1,377.75. On November 18, 2015, detectives of the Lehigh County District Attorney’s Office had filed a Criminal Complaint charging the defendant with Insurance Fraud. According to the
complaint, it was alleged that the defendant registered and insured his 1992 Cadillac by utilizing an Easton,
PA address; however, the defendant’s actual address is that of Phillipsburg, NJ. The defendant admitted during an interview that he has been residing in New Jersey for several years and that he obtained his auto insurance through an agency in Allentown, PA. [OTN: T7039270]
On November 20, 2015, Carl Eugene Santavicca of Uniontown, PA pled Guilty to Acquire or Obtain Possession of Controlled Substance and was sentenced to 23 months in an Intermediate Punishment Program and
was ordered to pay $400 in fines and court costs totaling $2,451.25. Office of Attorney General special agents
had charged Santavicca with Conspiracy, Acquire or Obtain Possession of Controlled Substance and Manufacture, Delivery or Possession with Intent to Manufacture or Deliver. According to the Criminal Complaint,
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 complaint, between
January 9, 2012 and August 7, 2014, Ainsley allegedly prescribed hydrocodone to patients to include Santavicca who had agreed to return all or a portion of the Schedule III controlled substance to him for his own per-
Bogus Injury
Claim Against
SEPTA Results
in Probation
Page 16
Know the Risks, Know the Penalties
Fraud Stories (Continued)
sonal 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, 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 complaint include CVS Caremark and Highmark Express Scripts. [OTN:
T6266735, T6265696]
On November 20, 2015, Jerome D. Young of Bethlehem, PA pled No Contest to Criminal Attempt Theft by
Deception-False Impression and was ordered to pay $250 in fines and court costs of $712.50. On April 13,
2015, detectives of the Lehigh County District Attorney’s office filed a Criminal Complaint charging Young
with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on
April 17, 2014 prior to 3:27 PM, Young reported to his landlord that a septic pipe broke and released sewage in
his basement. Young’s landlord contacted a repair company at 3:27 PM and they arrived at Young’s residence
“Young reportedly
submitted a proof of loss
valued at $10,715.72;
to make repairs at approximately 4:30 PM. The complaint reflects that Young did not have a renter’s insurance
policy until 4:30 PM on April 17, 2014, when he contacted Erie Insurance Company to purchase a renter’s
policy after the incident had already occurred, and the complaint states that at 5:05 PM, Young reported that
the pipe had just burst and released sewage into the basement of his residence. Young reportedly submitted a
proof of loss valued at $10,715.72; however, Erie had not paid Young’s claim as the investigation revealed that
he had not purchased the renter’s policy until after the incident occurred. [OTN: L9349830]
however, Erie had not
paid Young’s claim as the
investigation revealed
that he had not
purchased the renter’s
policy until after the
incident occurred.”
On November 24, 2015, an Etters, PA woman was granted ARD with 12 months' probation and was ordered to
perform 35 hours of community service and pay $5,465 in restitution and $1,831.50 in court costs. On March
16, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint charging the
defendant with Insurance Fraud, Theft by Deception-False Impression and Forgery. According to the complaint, it was alleged that the defendant filed multiple fraudulent injury claims on behalf of herself and her livein 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]
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
*April 7—8, 2016 — PA 2015 Insurance Fraud Conference — Hershey Lodge & Convention
Center, Hershey, PA
National & State Anti-Fraud Events Offer New Knowledge & New Contacts
Page 17
Who to Call
Page 18
Insurance Fraud
Allegheny County DA’s Office, (412) 461-2328
Allegheny County PD, (412) 473-1254
Attorney General’s Office, (717) 787-0272
Bucks County DA’s Office, (215)348-6344
PA INSURANCE FRAUD
PREVENTION
AUTHORITY
6 Kacey Court, Ste. 101
Mechanicsburg, PA 17055
Phone: 717-691-1828
Fax: 717-697-1013
Cumberland County DA’s Office, (717) 240-7764
Delaware County DA’s Office, (610) 891-4700
Erie Bureau of Police, (814) 870-1258
Lehigh County DA’s Office, (610) 264-8758
Montgomery County DA’s Office, (610) 278-3472
NE Insurance Fraud Task Force, (570) 963-5177
Philadelphia DA’s Office, (215) 686-8723
York County DA’s Office, (717) 771-9600 x 329
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]