Arrests for September 2011
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 1-800-342-3736
Newburgh, N.Y., resident Penelope Moxley pleaded guilty to falsely reporting an incident and was sentenced to a conditional discharge. She falsely reported to GEICO Insurance Company that her 2007 Dodge Caravan was stolen. However, an investigation by the Insurance Frauds Bureau revealed that the van was found burning in New York City at a time when Moxley stated that it was in her possession in Newburgh.
- NO COVERAGE
Arrested on 9/30/11
Charged with violation of Section 114 of the Workers’ Compensation Law
The defendant in this case presented an Acord Certificate of Insurance to a contractor as proof that he had workers’ compensation coverage for the 6/10/09-6/10/11 period. However, an audit by the State Insurance Fund revealed that no such coverage existed. On 9/29/11, investigators met with the defendant at his home. He requested an attorney and agreed to turn himself in the following day. On 9/30/11, he surrendered and was charged with violation of the Workers’ Compensation Law. The Insurance Frauds Bureau and the State Insurance Fund conducted the investigation that led to his arrest.
- PAWN TICKETS TRIP UP SUSPECT
Arrested on 9/29/11
Charged with insurance fraud in the 4th degree, criminal possession of a forged instrument in the 2nd degree and grand larceny in the 4th degree
At the request of the Greece, N.Y., Police Department, the Insurance Frauds Bureau opened an investigation into a homeowners insurance claim filed with Allstate Insurance Company by the defendant. He maintained that his home was burglarized and electronics and jewelry worth $3,000 were taken. During the investigation, the Greece PD learned that the defendant had pawned some jewelry after the purported burglary. Investigators from the Insurance Frauds Bureau and the Greece PD retrieved pawn receipts showing that the defendant had sold several items of jewelry to the shop, one of which was a ring. They took the ring as evidence and the defendant’s estranged wife subsequently identified it as one of the items reported stolen. Further investigation revealed that the defendant had forged his wife’s signature on a $1,492 check issued by Allstate in settlement of the claim.
- NONPAYMENT OF PREMIUMS
Arrested on 9/23/11
Charged with insurance fraud in the 3rd degree, offering a false instrument for filing and violation of Section 114.1 of the Workers’ Compensation Law
An investigation by the Insurance Frauds Bureau and the State Insurance Fund led to the arrest of the owner of a Westchester County landscaping business. On 11/12/10, the defendant filed an application with the Fund for workers’ compensation insurance. He stated on the application that he did not have prior insurance coverage with the Fund. However, investigators learned that in 2006, the defendant had a Fund policy that was cancelled for nonpayment with $15,000 in premiums due.
- TASK FORCE ARRESTS
Arrested on 9/22/11
Charged with criminal possession of a forged instrument in the 2nd degree and criminal possession of a controlled substance in the 3rd degree
There were four additional arrests in an ongoing investigation being conducted by the Drug Enforcement Administration Task Force of which the Insurance Frauds Bureau is a member. Each of the suspects was charged with criminal possession of a forged instrument and criminal possession of a controlled substance.
Arrested on 9/21/11
Charged with insurance fraud in the 3rd degree, offering a false instrument for filing in the 1st degree and violation of Section 114.1 of the Workers’ Compensation Law
A Cortland, N.Y., man sustained a work-related back injury on 8/23/03 and began collecting workers’ compensation benefits. During the period from 1/1/11 to 10/10/11, he submitted several Work Activity Reports to the State Insurance Fund stating that he had not returned to work nor received payment for employment since his injury. However, an investigation by the Insurance Frauds Bureau, the State Fund and the Cortland City Police Department revealed that during that time period, he was incarcerated in the Marcy Correctional Facility for the sale of drugs, from which he admitted to obtaining financial gain. As a result, he collected $15,200 in benefits to which he was not entitled.
- HEALTH CARE FRAUD SUSPECT #4
Arrested on 9/21/11
Charged with health care fraud
In a continuing investigation conducted by the Insurance Frauds Bureau and U.S. Department of Health and Human Services Office of the Inspector General, a fourth suspect was charged with health care fraud. Three suspects had previously been arrested in connection with a scheme to steal blank prescription pads, write prescriptions for controlled substances and have them filled. Further evidence indicated that this fourth suspect had allegedly stolen prescription pads from medical facilities, sold some of the pads and filled prescriptions for controlled substances with the remaining pads. He then sold the medications he illegally obtained. A search warrant was executed at his Bronx residence on 9/21/11 and he was arrested. (See HEALTH CARE FRAUD SUSPECTS #1, 2 and 3 below.)
- FRAUDULENT CLAIMS HANDLING COMPLAINT
Arrested on 9/20/11
Charged with insurance fraud in the 3rd degree and grand larceny in the 3rd degree
A New York City man was accused of filing nine fraudulent claims with Aetna Insurance Company for medical treatment he allegedly received. One claim was for dates of service by a particular doctor in January 2010. However, an investigation by the Insurance Frauds Bureau disclosed that the doctor in question had died in August 2009. Several other claims indicated treatment by another doctor at NYU Langone emergency room. In this instance, investigators found that there was no such doctor associated with NYU. In fact, the State Education Department Office of the Professions had no record of a health care provider with the name given on the suspect’s claims. After filing the claims and before the investigation was initiated, the suspect wrote to the Superintendent of Insurance twice and spoke to him on one occasion to complain about Aetna’s handling of his claims. The nine claims filed totaled $22,570 of which Aetna paid $11,256.
- COLLISION BUT NO COVERAGE
Arrested on 9/14/11
Charged with insurance fraud in the 5th degree and falsifying business records in the 1st degree
On 6/28/11, a Syracuse man reported to his insurer that he was involved in an accident while driving his 2005 Chevy Corvette on 6/27/11 at about 5:00 p.m., causing more than $7,000 in damages. However, an investigation revealed that the accident had actually occurred at about 1:00 p.m. on 6/27/11. Since he had no collision coverage at the time, he contacted his insurer at 3:00 p.m. that same day, added the coverage, and filed a claim in an effort to have the insurer pay for repair of the damages.
- BIG TIME NO-FAULT FRAUD SCHEME
Arrested on 9/13/11
Charged with insurance fraud in the 5th degree, grand larceny in the 3rd and 4th degrees, attempted grand larceny in the 3rd and 4th degrees, falsifying business records in the 1st degree and conspiracy in the 5th degree
Twelve suspects were indicted for their participation in a no-fault fraud scheme. Eight of the suspects were arrested on 9/13/11 and four others are being sought. The indictment charged that these suspects allegedly staged auto accidents to generate fraudulent billing for unnecessary medical treatments and for coaching legitimate accident victims to exaggerate injuries. They were accused of defrauding numerous insurers of more than $45,000. The Insurance Frauds Bureau, the NYPD’s Fraudulent Accident Investigations Squad, the Queens DA’s Office and the SIUs of Progressive, GEICO and Safeco Insurance Companies collaborated on the investigation that led to the arrests.
- HEALTH CARE FRAUD SUSPECTS #1, 2 and 3
Arrested on 9/9/11
Charged with health care fraud
An investigation by the Insurance Frauds Bureau and the U.S. Department of Health and Human Services Office of the Inspector General uncovered evidence that two men and a woman were involved in a scheme to steal blank prescription pads, write prescriptions for controlled substances (i.e., oxycodone), and have them filled. On 8/25/11, search warrants were executed at two residences in the Bronx and evidence was seized that supported the investigation’s findings. The two men were arrested on 8/25/11 and the woman on 9/9/11 for allegedly running a fraudulent prescription drug ring out of their homes which were the search locations. This investigation is ongoing.
- WRONG KEY
Arrested on 9/7/11
Charged with insurance fraud and false written statement
A Nassau County man reported to the NYPD and GEICO Insurance Company that his 1999 Chevy Suburban had been stolen and was requested by the insurer to turn the car key over to GEICO. However, an investigation by the Insurance Frauds Bureau and the NYPD’s Auto Crime Division revealed that the key he gave to GEICO was not the key that was issued with the car, the only key that would start the car. A forensic examination proved that the originally issued key was used to move the allegedly stolen car. The examination also found no damage to the ignition or door locks.
- PRIOR SUPPLEMENTS
- RESTAURANT SET AFIRE
Arrested on 8/31/11
Charged with arson in the 2nd degree
An investigation by the Insurance Frauds Bureau and the NYPD’s Arson Explosion Squad led to the arrest of the owner of an East Village restaurant. Evidence uncovered during the investigation indicated that he intentionally set fire to the restaurant for the insurance proceeds. The superintendent of the building that housed the restaurant was walking by and noticed broken glass on the sidewalk and flames inside the restaurant, and called 911. The fire was subsequently deemed incendiary by the FDNY Fire Marshals.
- FRAUDULENT CERTIFICATES
Arrested on 8/30/11
Charged with insurance fraud in the 4th and 5th degrees
An investigation conducted by the Insurance Frauds Bureau resulted in the arrest of two contractors charged with insurance fraud. Defendant #1 in this case completed a roofing job for a residential customer and when the customer asked for proof of insurance coverage, he provided Certificates of Insurance. However, investigators discovered that he had no coverage for either workers’ compensation or liability insurance. He “borrowed” the legitimate Certificates of Insurance from another contractor, Defendant #2 in this case. The customer had never heard of Defendant #2 or his company before seeing the Certificates.
- NONEXISTENT INJURIES
Arrested on 8/25/11
Charged with grand larceny in the 3rd degree, insurance fraud in the 3rd degree, falsifying business records in the 2nd degree and offering a false instrument for filing in the 2nd degree
A Queens County man became suspect #56 in an ongoing, long-term investigation involving no-fault fraud. He allegedly added his name to a Police Accident Report as being injured in an auto accident. He subsequently sought and received medical treatment for nonexistent injuries under the no-fault portion of his auto insurance policy. GEICO Insurance Company subsequently paid out $3,000 in benefits based on his fraudulent claims. His arrest was the result of an investigation conducted jointly by the Insurance Frauds Bureau and the NPYD’s Fraudulent Accident Investigations Squad.