Arrests for December 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!
*********************************************
-
SENTENCED
On 12/22/04, Roshonda Johnson was sentenced in the Town of Webster Court to three years' probation and fined $300 for her part in a scheme to defraud Excellus Blue Cross/Blue Shield. Her sister and co-defendant, Aquila Campbell, was sentenced on 10/13/04 to three years' probation and ordered to pay $1,342 in restitution to Excellus. An investigation by the Frauds Bureau, the Webster Police Department and Excellus led to the arrest of the sisters in May 2004. 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 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.
- NO COVERAGE
Arrested on 12/22/04
Charged with criminal possession of a forged instrument, falsifying business records, grand larceny and petit larceny
In her capacity as a bookkeeper for a construction company, the suspect in this case presented to two local companies Certificates of Insurance stating that her employer had workers' compensation coverage through the State Insurance Fund. However, a joint investigation conducted by the Frauds Bureau, the State Police, the Workers' Compensation Fraud Inspector General's Office and the Fund uncovered evidence that the suspect altered a 2001 Certificate to indicate that the construction company had coverage in 2002-2003. In fact, no such coverage existed. As a result of her actions, her employer paid $2,043 less in premiums than was actually owed to the Fund.
- FAMILY TIES
Arrested on 12/21/04
Charged with grand larceny in the 3rd degree and criminal possession of a forged instrument in the 2nd degree
An investigation by the Frauds Bureau and the State Insurance Fund led to the arrest of an upstate woman accused of cashing workers' compensation checks made payable to her mother-in-law. The rightful beneficiary died on July 8, 2003 but this fact was never reported to the Fund. As a result, the Fund continued to issue checks totaling $5,576.60 from September 2003 through March 2004 which the defendant in this case cashed and pocketed the benefits to which she was not entitled.
- DAMAGED GOODS
Arrested on 12/17/04
Charged with insurance fraud in the 3rd degree and attempted grand larceny in the 3rd degree
The defendant in this case reported to the Hamburg Town Police on 6/26/01 that his 1999 Honda motorcycle was damaged by a hit-and-run driver. He then filed a claim with Progressive Insurance Company for $11,770 in damages. However, an investigation by the Frauds Bureau and Progressive Insurance Company revealed that the motorcycle had been involved in an accident in South Dakota, where it was taken to a salvage yard owned by the suspect's brother and purchased by the suspect in its damaged condition. Photos obtained from the insurer of note in South Dakota showed the damage to the motorcycle from the original accident was identical to the damage on the claim the suspect filed with Progressive. He initially stated that he had had the motorcycle repaired but subsequently withdrew his claim.
- CALL A PLUMBER
Arrested on 12/13/04
Charged with fraudulent practices under the Workers’ Compensation Law
An investigation by the Frauds Bureau led to the arrest of a Suffolk County plumber who was accused of submitting a fraudulent Certificate of Insurance to a construction company. In order to get paid for plumbing work he had completed, he presented false evidence of workers' compensation insurance coverage.
- PHONY ACCIDENT REPORT
Arrested on 12/9/04
Charged with insurance fraud in the 2nd and 3rd degrees, forgery in the 2nd degree, grand larceny in the 3rd degree and falsifying business records in the 1st degree
This suspect, acting in concert with others, submitted a fraudulent Police Accident Report to GEICO and Windsor Insurance Companies for an accident he was not involved in, in an effort to claim medical benefits under his no-fault auto insurance. The Frauds Bureau and the NYPD's Fraudulent Accident Investigation Squad pooled resources in this investigation.
- DOUBLE TROUBLE
Arrested on 12/7/04
Charged with insurance fraud in the 4th degree and grand larceny in the 4th degree
An investigation by the Frauds Bureau, the State Police, the Monroe County DA's Office, the City of Rochester Police Department and the DMV, with the assistance of Safeco Insurance Company's Special Investigations Unit, led to the arrest of twin brothers, the co-owners of an auto repair shop in Rochester, on charges of felony insurance fraud and grand larceny. These are the first arrests stemming from a Department of Criminal Justice Services grant received by the Monroe County DA's Office to establish a unit dedicated to combating auto theft and insurance fraud. Acting on a tip received by the Frauds Bureau, investigators conducted an undercover operation at the shop. They deliberately damaged a vehicle and filed a claim with Safeco. Before bringing the vehicle into the shop, the investigators identified and secretly marked parts that needed to be replaced. The shop was paid up front for new parts to replace the damaged parts and for general repair of the car. However, a re-examination of the car showed that a number of parts ordered and paid for had not been replaced, in some instances compromising the safety of the car. This matter was also referred to the Department of Motor Vehicles which licenses and monitors auto repair shops in New York State.
- NO BENEFITS IN JAIL
Arrested on 12/7/04
Charged with attempted petit larceny and violation of the Workers' Compensation Law
A New York City man sustained a work-related injury on January 12, 2001 and subsequently filed for workers' compensation benefits. Then on July 8, 2003, he was arrested, convicted and sentenced to one year in jail on a burglary charge, a fact he neglected to tell the Workers' Compensation Board. His girlfriend attended a Board hearing on July 17, 2003 allegedly accompanied by the claimant's brother who represented himself as the claimant and testified that he was still unable to work. A benefit check that was issued to the incarcerated claimant subsequent to the hearing was forged by the girlfriend and cashed through her father's business. An investigation by the Frauds Bureau resulted in the arrest.
- NO BENEFITS IN JAIL II
Arrested on 12/3/04
Charged with offering a false instrument for filing
The defendant in this case was charged with neglecting to inform the State Insurance Fund that he had been arrested and sentenced to prison. While he was in jail, he allegedly continued to receive workers' compensation benefits to which he was not entitled. The Frauds Bureau and the Nassau County DA's Office worked jointly on the investigation that led to his arrest.
PRIOR SUPPLEMENTS
NOVEMBER 2004
-
GAMING THE SYSTEM
Arrested on 11/12/04
Charged with insurance fraud, workers' compensation fraud, offering a false instrument for filing and grand larceny
An investigation by the Frauds Bureau, the State Insurance Fund and the Workers' Compensation Fraud Inspector General's Office resulted in the arrest of an upstate resident on charges of bilking the workers' compensation system. The defendant sustained a work-related injury in March 1992 and in January 1995, he was granted a Permanent Partial Disability by the Workers' Compensation Board. The determination required the Fund to pay him $194 a week and allowed him to earn an additional $145 without affecting his claim. Over the intervening years, he regularly submitted statements to the Fund maintaining that he was not employed. However, during the investigation, evidence was uncovered that the defendant began working as an auto mechanic in the spring of 2002, earning between $150 and $300 a week. As a result, he received more than $6,900 in benefits to which he was not entitled.
