Arrests for September and October 2012
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 1-888-372-8369
CAUGHT!
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October 2012
- SENTENCED
William Uris of Saratoga Springs was sentenced on 10/2/12 to six months in jail followed by five years’ probation and ordered to pay $127,560 in restitution. In August 2012, he had pleaded guilty to grand larceny and attempted grand larceny. As part of his plea, he admitted that from February 2008 to June 2011, he schemed to defraud HealthyNY, a state-sponsored program created to provide low-cost health insurance for small businesses that cannot afford traditional health plans, and MVP Health Care of Schenectady. Uris falsely reported that certain businesses were qualified to obtain the HealthyNY benefits, in turn making commissions on the coverage. In addition, he told the businesses that in order to obtain the coverage, they would have to join his National Business Owner’s Association for which he charged them a fee for membership. At the time of his sentencing, Uris paid $100,000 of the total restitution, all but $5,700 of which will be reimbursed to the eight businesses for the fees they paid for membership in Uris’s bogus association. The rest will be paid to the state for fraudulent claims that were paid out. Uris also agreed to surrender his insurance broker license and not engage in any insurance business for the five years of his probation. During his probation, he must make monthly payments on the nearly $28,000 he will still owe the state. The investigation that led to his arrest was conducted by the Criminal Investigations Unit Frauds Bureau, MVP’s Special Investigations Unit and the Schenectady County DA’s Office.
- GUILTY PLEA
On 10/25/12, Remus M. Nowak, a.k.a. Remus Rose, of Tonawanda, N.Y., pleaded guilty before the Erie County Supreme Court to grand larceny in the 3rd degree and insurance fraud in the 3rd degree. He admitted that he filed a fraudulent claim for lost wages with New York Central Mutual Insurance Company following a 5/17/09 auto accident. As a result of the fraud, he collected $40,000 in no-fault benefits to which he was not entitled. He was arrested on 5/11/12 following an investigation by the Criminal Investigations Unit Frauds Bureau and the Erie County DA’s Office.
- NO DEER INVOLVED
Arrested on 10/26/12
Charged with attempted grand larceny in the 3rd degree
On 6/2/12, the suspect in this case reported to the Greece Police Department and New York Central Mutual Insurance Company that he had a motor vehicle accident caused by a collision with a deer. The Police took a motor vehicle accident report at the scene. He subsequently obtained an estimate of the damage and submitted it to the insurer with a claim for $3,054. The insurer had an appraiser review the damage and it was determined that the damage was not related to a deer collision. When confronted with the evidence, the suspect admitted that he had not hit a deer and offered to withdraw his claim. He confessed to investigators in a written statement that he had hit a guardrail on an expressway and reported the purported deer collision in order to avoid paying a deductible. His arrest was the result of an investigation by the Criminal Investigations Unit Frauds Bureau and the State Police.
- UNPAID PREMIUMS
Arrested on 10/18/12
Charged with grand larceny in the 3rd degree
A Queens business owner reported on an application for workers’ compensation insurance that his company had never been insured through the State Insurance Fund. In addition, the application stated that he had never been in business under a different name. However, an investigation by the Criminal Investigations Unit Frauds Bureau revealed that he had in fact previously been an officer of a separate company that had been insured through the State Fund. As a result of his actions, the State Fund lost $9,324 in premiums owed by this defendant.
- FORGED CERTIFICATES
Arrested on 10/17/12
Charged with forgery in the 2nd degree and insurance fraud in the 5th degree
The owner of a pool installation company in upstate New York was arrested for his participation in a scheme to commit workers’ compensation fraud. When interviewed by investigators on 4/19/12, he admitted that he had forged Certificates of Liability indicating his business was insured by Midstate Insurance Company. As a result, he was issued five building permits to install pools when no liability coverage was in place. A joint investigation by the Criminal Investigations Unit Frauds Bureau and the Tonawanda Police Department resulted in his arrest.
- FRAUDULENT APPLICATION
Arrested on 10/17/12
Charged with grand larceny in the 2nd degree, insurance fraud in the 2nd degree, falsifying business records and violation of Sections 96 and 114.1 of the Workers’ Compensation Law
An investigation by the Criminal Investigations Unit Frauds Bureau led to the arrest of a Queens, N.Y., man who applied for and was issued a policy of workers’ compensation insurance by the State Insurance Fund. However, investigators found evidence that the defendant knowingly submitted documents in support of the application that contained materially false information. As a result, he defrauded the State Fund of $50,000 in premiums.
- MATERIAL MISREPRESENTATION
Arrested on 10/16/12
Charged with grand larceny in the 2nd degree, insurance fraud in the 2nd degree and violation of Sections 96 and 114.1 of the Workers’ Compensation Law
The defendant in this case supplied documents to the State Insurance Fund that she allegedly knew were false. An investigation by the Criminal Investigations Unit Frauds Bureau, the State Insurance Fund and the Queens DA’s Office revealed that she had lied about the amount her contracting company made in sales, as well of the number of employees on her payroll. As a result of the fraud, she avoided paying the State Fund $114,127 in premiums owed.
- NO REPAIRS DONE
Arrested on 10/10/12
Charged with insurance fraud in the 4th degree and falsifying business records in the 1st degree
On 7/23/12, a Rochester woman reported to State Farm Insurance Company that a pipe under her kitchen sink leaked into her basement during installation of a dishwasher, causing approximately $8,000 in damage. She subsequently submitted a proof-of-loss document and a $2,810.60 receipt in support of her claim, stating that she had taken several electronic items damaged in the leak to be repaired. An investigation was initiated by the Criminal Investigations Unit Frauds Bureau and the State Police during which investigators contacted the owner of the repair shop the defendant claimed had done the repair work who reported that the receipt was fraudulent. During an interview, the defendant admitted forging the receipt because she claimed that she had disposed of the damaged property before her insurer told her to get an estimate.
- MEDICAID FRAUD
Arrested on 10/10/12
Charged with offering a false instrument for filing in the 1st degree and falsifying business records in the 1st degree
On 8/3/12, the Office of the Medicaid Inspector General contacted the Criminal Investigations Unit Frauds Bureau’s Rochester Office to report suspicions that a woman had submitted false documentation when she applied for Medicaid in June 2008 and again when she filed for renewal of her Medicaid benefits in May 2011. On 8/22/12, a Frauds Bureau investigator interviewed the suspect and she provided a voluntary statement that she had failed to report that she is legally married and had withheld information concerning her husband’s income. In addition, she neglected to report rental income she receives from a property she owns.
- NO EXEMPTION WARRANTED
Arrested on 10/9/12
Charged with offering a false instrument for filing in the 1st degree and violation of Section 114 of the Workers’ Compensation Law
An investigation by the Workers’ Compensation Board’s Office of the Fraud Inspector General with the assistance of the Criminal Investigations Unit Frauds Bureau resulted in the arrest of an upstate business owner charged with participating in a scheme to defraud the workers’ compensation system. He submitted exemption certificates stating that he did not have any employees and therefore was not required by law to purchase workers’ compensation coverage. However, an investigation uncovered evidence indicating that he did in fact have employees on his payroll. As a result, his workers were without proper coverage and he evaded paying premiums for the necessary coverage.
- USED PARTS BILLED AS NEW
Arrested on 10/5/12
Charged with insurance fraud in the 3rd and 4th degrees, attempted grand larceny in the 3rd degree, grand larceny in the 4th degree and scheme to defraud in the 1st degree
The owner of an auto body shop in Bedford, N.Y., was arrested on multiple felony charges in connection with repairs made to three New York State Police vehicles. An investigation conducted jointly by the Criminal Investigations Unit Frauds Bureau and the Westchester County DA’s Office revealed that he billed insurers for new parts purportedly installed in the vehicles when in fact he provided used parts.
- TASK FORCE TAKEDOWN
Arrested on 10/4/12
Charged with health care fraud, wire fraud, violations of the kickback statutes and money laundering
On 10/4/12, the FBI New York Health Care Fraud Task Force, of which the Criminal Investigations Unit Frauds Bureau is a member, was part of a takedown conducted by a nationwide strike force that resulted in charges against 92 suspects in schemes to defraud the Medicare and Medicaid programs of $432 million in fraudulent claims. Of those arrested, 15 were suspects in three New York Task Force cases. In one New York case, nine people, including the manager and medical director of a medical facility in Brooklyn, were charged with conspiring to defraud the Medicare and Medicaid programs of more than $13 million by submitting fraudulent claims for physical therapy that was not provided or was medically unnecessary. In another case, four licensed chiropractors allegedly failed to provide chiropractic services to patients residing in assistant living facilities, yet billed Medicare for $6.4 million. In the third case, the office manager of a Queens medical clinic and the owner of an ambulette service received $3 million from Medicare after claiming to provide physical therapy and diagnostic tests to patients who were paid cash kickbacks to use these two defendants’ medical and ambulette services.
September 2012
- DUO IN CAHOOTS
Arrested on 9/10/12
Charged with falsifying business records in the 1st degree and insurance fraud in the 3rd degree
An investigation by the Criminal Investigations Unit Frauds Bureau resulted in the arrest of a retired optician and the manager of a vehicle repair shop for their participation in a scheme to collect an insurance payout based on a fraudulent claim. The retired optician submitted a $15,000 claim to New York Central Mutual Insurance Company for damage to his tractor, providing three written statements reporting that the tractor was damaged while on his trailer. If that were the case, the cost of repairing the damage would be covered by his insurer. The repair shop manager supported the claim in a written statement, reporting that he had found the tractor on the trailer and that the optician himself had brought it into his shop for repair. However, investigators found evidence indicating that the tractor was actually damaged when the owner was digging with a back hoe on his property. The repair shop owner was present when that damage occurred and it was he who transported the damaged tractor to his shop on the shop’s truck.
- RETURNED FOR REFUND
Arrested on 9/8/12
Charged with insurance fraud in the 4th degree, falsifying business records in the 2nd degree and attempted grand larceny in the 4th degree
A Rochester man reported to State Farm Insurance Company on 2/20/12 that his home had been burglarized and items worth $15,899 were stolen. In support of his claim, he submitted a proof-of-loss listing of the items and several receipts. One receipt from Best Buy listed $2,019.27 worth of electronics and video games. However, an investigation by the Criminal Investigations Unit Frauds Bureau and the Rochester Police Department confirmed that the items reported as purchased at Best Buy had in fact been returned to Best Buy for refund prior to the date of loss.
