Arrests for October 2004
These arrests were made possible through the cooperation of the Frauds Bureau, law enforcement, the insurance industry and the public.
To report suspected incidents of insurance fraud, call 1-888-FRAUDNY
CAUGHT!
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SENTENCED
- A Rochester receptionist, Aquila Campbell, was sentenced on 10/13/04 to three years' probation and ordered to pay $1,342 to Excellus Blue Cross/Blue Shield for her part in a scheme to defraud the insurer. An investigation by the Frauds Bureau, the Webster Police Department and Excellus led to the arrest of the woman and her sister, Roshanda Johnson, on 5/21/04. The investigation revealed that Johnson had suffered an accident at home that required emergency dental treatment. However, she did not have dental coverage so she and Campbell, who did have coverage, agreed that the emergency treatment would be sought using Campbell's name and dental insurance identification. Johnson was treated at the Rochester General Hospital Dental Unit and released. She then received follow-up treatments at a local dental office from January through March 2003, again using her sister's name and insurance ID. Excellus paid out more than $2,100 for the treatments. Campbell reported to the dental office and to the Webster Police Department that someone had stolen her identity and obtained the treatments without her knowledge. When confronted with the evidence turned up during the investigation, both sisters confessed to the fraud. On 10/13/04, Johnson pled guilty to insurance fraud. Her sentencing is scheduled for 12/22/04.
- Jay Fair, an employee of the Niagara County Risk Management Office, notified Independent Health (the County's health insurer) in June 1998 that he had gotten married and wanted his wife added to his employee health coverage. However, in March 2003, the County discovered that Fair was not married to the person added to his policy. An investigation by the Frauds Bureau and the Niagara County DA's Office led to his arrest on 10/12/04. He pled guilty to petit larceny and was sentenced to a conditional discharge. In addition, he paid $15,062 in restitution for the theft of premiums paid by the County for the additional coverage. In March 2004, the purported wife pled guilty to petit larceny and paid $2,000 in restitution to Independent Health for benefits paid to her under Fair's policy.
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GUILTY
- Clifford Travers, a revoked agent/broker, was convicted of petit larceny on 10/20/04 for misappropriating $8,000 in premiums from various clients. In addition, he took out a $3,100 loan on a client's insurance policy without the knowledge of the client and had the check mailed to his own home. The Frauds Bureau worked closely with the Nassau County DA's Office in the investigation that led to his arrest and conviction.
- Dwayne Peyton of Lackawanna, NY, pled guilty to felony mail fraud before a U.S. District Court Judge on 10/15/04. He admitted that he arranged with several car owners to stage thefts and cause heavy damage to the cars in staged accidents. As a result, the owners filed $64,280 in fraudulent claims of which insurers paid out more than $29,000 before the scheme was uncovered. The efforts of the Frauds Bureau, the U.S. Postal Inspector's Office, the State Police and the Cheektowaga Police Department resulted in his arrest in August 2003 and subsequent conviction. The investigation is ongoing.
- AVOIDANCE
Arrested on 10/12/04
Charged with violation of the Workers' Compensation Law
The Frauds Bureau and the Suffolk County DA's Office conducted an investigation that led to the arrest of a Long Island carpenter on charges that he submitted an application to the State Insurance Fund for workers' compensation and employer's liability insurance knowing that it contained false information. His motive was to avoid paying $28,253 in back premiums.
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AN ACCIDENT WAITING TO HAPPEN
Arrested on 10/7/04
Charged with falsifying business records in the 1st degree, falsely reporting an incident, making a punishable false written statement and aggravated unlicensed operation of a motor vehicle in the 2nd and 3rd degrees
An upstate man and woman reported to the Otsego County Sheriff's Office that they had been involved in an auto accident and needed an accident report because the woman had received treatment for minor injuries at a local emergency room. When investigators from the Sheriff's Office interviewed the couple, they were told that she was the driver at the time of the accident. However, an investigation by the Frauds Bureau and the Sheriff's Office revealed that the man had actually been driving the car. They lied to cover the fact that his driver's license was revoked at the time of the accident for a 2001 DWI conviction and having been issued three speeding tickets within an 18-month period.
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DEMOLITION AIN'T LAWN MAINTENANCE
Arrested on 10/5/04
Charged with offering a false instrument for filing in the 1st degree, insurance fraud in the 3rd degree and fraudulent practices under the Workers' Compensation Law
In October 2003, the defendant in this case filed an application with the State Insurance Fund for workers' compensation insurance for his company, stating that he had one employee and that the principal activity of the company was lawn maintenance. Based on information received by the Fund, the Frauds Bureau, the Workers' Compensation Fraud Inspector General's Office and the Fund conducted an investigation that uncovered evidence that the suspect's company had several employees and was involved in building demolition. As a result, the suspect paid $19,338 less in premiums than he would have if he had accurately reported the size of his work force and the true nature of his business.
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MOTORCYCLE MADNESS
Arrested on 10/5/04
Charged with insurance fraud in the 3rd degree and attempted grand larceny in the 3rd degree
This suspect reported to Progressive Insurance Company that on 6/13/04 his 1998 Lincoln Navigator was struck by a motorcycle while parked in his driveway and he filed a claim for $4,863. An investigation conducted jointly by the Frauds Bureau, the Niagara County Sheriff's Department and the Niagara County DA's Office brought evidence to light indicating that much of the damage to the car had occurred before the motorcycle accident.
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MISREPRESENTATION
Arrested on 10/4/04
Charged with violation of the Workers' Compensation Law
An investigation by the Frauds Bureau and the State Insurance Fund led to the arrest of a Long Island man for knowingly filing an application for workers' compensation and employer's liability insurance that contained materially false information. As a result, this defendant owes the Fund $13,570 in back premiums.
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WORKERS' COMP FRAUD
Arrested on 10/1/04
Charged with insurance fraud in the 5th degree, perjury in the 3rd degree and petit larceny
Following a work-related accident on 4/25/02, a Queens man began collecting workers' compensation benefits and during that time he testified under oath that he had not worked since his accident. However, an investigation by the Frauds Bureau and the Queens DA's Office revealed that he was in fact gainfully employed.
PRIOR SUPPLEMENTS
SEPTEMBER 2004
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GUILTY
Josephine Giaquinto and Ivan Westbrook, two partners in a bogus dental insurance business they operated in eight New York counties, pled guilty on 9/9/04 to enterprise corruption. The president of the company, Leonard Friscia, pled guilty to the same charge on 9/23/04. In the spring of 2001, the Insurance Department's Consumer Services Bureau began an investigation based on a complaint by an insurance agent from Orange County, NY. The agent reported that he had sold a number of the company's insurance policies to business owners for their employees and also to individuals. Several of the policyholders had begun to complain that their claims were not being paid. Early in the investigation, the Consumer Services Bureau learned that the company, Preferred Dental Care, was not licensed to do business in New York State and the case was referred to the Frauds Bureau for criminal investigation. The investigation revealed that these three suspects collected more than $1 million in premiums from unwitting customers in Putnam, Ulster, Rockland, Dutchess, Orange, Schenectady, Sullivan and Albany Counties. In Albany County alone, there were about 150 individuals defrauded. Sentencing is scheduled for early November 2004. They will be required to pay $1.3 million in restitution. The Insurance Department's Health and Consumer Services Bureaus, as well as the U.S. Postal Inspector's Office, provided assistance in the investigation.
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NO ACCIDENT
Arrested on 9/28/04
Charged with insurance fraud, grand larceny, falsifying business records, scheme to defraud and petit larceny
An investigation by the Frauds Bureau and the Brooklyn DA's Office led to the arrest of a woman who submitted a Police Accident Report for an accident that never took place. She subsequently submitted a $3,000 claim to State Farm Insurance Company in an effort to collect no-fault insurance benefits.
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ANOTHER NO ACCIDENT
Arrested on 9/28/04
Charged with insurance fraud, grand larceny and falsifying business records
A Brooklyn woman was accused of submitting a Police Accident Report for an accident that never occurred. The suspect filed a claim with Allstate Insurance Company for more than $3,000 in no-fault benefits and also filed a bogus $50,000 law suit. Her arrest was the result of the efforts of the Frauds Bureau and the Brooklyn DA's Office.
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[UN]ENTITLED
Arrested on 9/27/04
Charged with perjury, grand larceny, insurance fraud and fraudulent practices under the Workers' Compensation Law
An iron worker from Queens was arrested for submitting fraudulent documentation about his employment status to the State Insurance Fund in an effort to collect $7,000 in workers' compensation benefits to which he was not entitled. The Frauds Bureau and the Queens DA's Office pooled resources in this investigation.
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ALTERED REPORT
Arrested on 9/20/04
Charged with insurance fraud and falsifying business records
An investigation by the Frauds Bureau and the NYPD's Fraudulent Accident Investigation Squad brought about the arrest of an unemployed Queens man on charges that he altered a legitimate Police Accident Report by adding his name as an injured party in the accident. He subsequently received treatment for bogus injuries and filed for no-fault insurance benefits.
JUNE 2004
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UNTRUSTWORTHY
Arrested on 6/30/04
Charged with grand larceny, forgery and criminal possession of a forged instrument
Charges against a Nassau County woman stated that during 2002 and 2003, she collected premiums but failed to remit the money to an insurer. An investigation by Frauds Bureau and the Nassau County DA's Office revealed that she was not licensed to act as an insurance agent in New York State following a finding of untrustworthiness by the Insurance Department that resulted in the revocation of her license in 1987.
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HEAL THYSELF
Arrested on 6/15/04
Charged with insurance fraud and theft by deception
A New Jersey doctor was accused of billing the State Insurance Fund for over $500 for treatment he never provided. The Frauds Bureau and the State Insurance Fund conducted the investigation jointly.
