Fraud Roundup

December 11, 2006

Upland woman arrested for fraud and grand theft

A woman from Upland, Calif., has been arrested for insurance fraud and grand theft.

Investigators from the San Bernardino County, Calif., District Attorney’s Office conducted an investigation of Loretta Wolter-Pinkowski, 52, which revealed that she was hired in Jan. 1999 to work at a Kaiser telephone call center in Pasadena, Calif.

According to the DA’s office, she filed four workers’ compensation claims, only one of which was accepted by Kaiser. She claimed she had sustained a carpal tunnel injury and went off work in Feb. 2001. Wolter-Pinkowski allegedly began working from her home as a medical biller from April 2002 to Feb. 2003, where she earned in excess of $16,000, although she was receiving workers’ compensation benefits for her alleged injury. Wolter-Pinkowski failed to disclose this additional income to her insurance company, the DA’s office said.

On Nov. 12, 2006, Upland police officers arrested Loretta Wolter-Pinkowski at her residence in Upland on the felony arrest warrant and booked her into San Bernardino County jail. She has been ordered to appear in court on Dec. 20, 2006. Bail was set at $25,000.

Ameriplan settles allegations for $200,000

Montana State Auditor John Morrison announced he has reached a settlement agreement with AmeriPlan to resolve allegations of insurance and securities fraud. In July, Morrison issued a cease and desist order after charging AmeriPlan USA, its founding officers, Dennis and Daniel Bloom, and Shirl Shelley, a Montana resident, with numerous violations of both the Montana Insurance Code and the Montana Securities Act. The action taken against AmeriPlan was the first of its kind in Montana, relying on a new law governing medical care discount cards. Morrison requested the legislation last session to ensure that medical care discount card providers were legitimate before they were allowed to sell their products in Montana.

“This settlement agreement serves to remind medical discount card companies that protecting Montanans is our number one priority,” Morrison said. “If discount card providers refuse to play by our new rules, they will pay the price and won’t be allowed to operate in Montana.”

Under the agreement, AmeriPlan must pay an administrative fine of $200,000 and create a restitution fund for Montana customers who were duped by the company. Montana customers of AmeriPlan can expect to receive a letter informing them that they are eligible to submit a claim to the restitution fund. In addition, AmeriPlan is banned from marketing and selling its products in Montana for two years.

AmeriPlan and its agents and officers were accused of failing to contract with the medical care providers (including doctors, nurse practitioners, physician’s assistants and hospitals) they advertise as participants in AmeriPlan’s medical care discount program. The Auditor alleged that more than 700 Montana AmeriPlan members in the state were unable to use the discount cards because there were few, if any, providers in Montana. Additionally, AmeriPlan is charged with conducting an illegal pyramid promotional scheme because it sold “broker packages” to recruit memberships. Because the memberships were for discounts that did not exist, Morrison alleged there was no product being sold. AmeriPlan’s largest source of income in Montana was from the sales of “broker packages,” according to the Auditor’s charging document.

According to the auditor, AmeriPlan’s Web site and other advertising, including oral assertions from some of its agents, claimed to have medical care providers, dentists and chiropractors contracted to provide a discount through the purchase of its card. When the Auditor’s office investigated those claims, they were unable to find a medical care provider or chiropractor who honored the discount cards. The only dentist who had contracted with AmeriPlan was located in Forsyth and was on probationary status with the Montana Board of Dentistry for his unlawful activities in Colorado. The new law requires the discount card companies to have contracts for services with providers located within a 60 mile radius of the card holder.

The company was told to stop its activity in Nov. 2005, but AmeriPlan continued to market its discount cards until the matter was referred to Morrison’s legal staff in late April. Additional charges included securities fraud, using deceptive or fraudulent practices in the marketing of their discount cards, selling unregistered securities by unregistered salespersons and failure to stop marketing the cards when they were not properly registered.

The settlement agreement can be found at www.mt.gov/sao. Montanans’ with questions regarding the settlement are being directed to call the State Auditor’s Office at 800-332-6148.

Idaho resident sentenced for fraud

A Pocatello, Idaho, man received a one to seven year prison sentence for insurance fraud, Attorney General Lawrence Wasden said. Joshua K. Smith, 26, pleaded guilty to one count of insurance fraud and was sentenced in Sixth District Court in Pocatello. Sixth District Judge Peter McDermott also ordered Smith to pay $6,900 in restitution. The court suspended the prison sentence and ordered Smith to serve 60 days in the Bannock County Jail and seven years on probation.

In Jan. 2003, Smith purchased a CR 125 Honda motorcycle. A few weeks later, he attempted to sell the motorcycle without success. He then hid the motorcycle in a relative’s storage shed, called the police and reported the motorcycle stolen. Smith filed an insurance claim that was paid by State Farm Insurance.

In Aug. 2005, Smith sold the motorcycle to a co-worker for $1,200. Bingham County authorities discovered the motorcycle at the buyer’s residence after receiving an anonymous tip. The co-worker stated that he had purchased the motorcycle from Smith.The restitution order requires Smith to pay $5,700 to State Farm to reimburse the company for the payment made as a result of the fraudulent claim and $1,200 to reimburse Bingham County for the cost of storing the motorcycle.

Charles Hudson of the Idaho Department of Insurance investigated the case, which was prosecuted by Deputy Attorney General Ken Robins of the Attorney General’s Special Prosecutions Unit.

Detectives find more alleged fee overcharges by Arizona towing company

Phoenix authorities investigating possible fraud at a Mesa towing company uncovered an additional $107,000 in overcharged fees for tow-related services to customers or insurance companies.

A Maricopa County Sheriff’s Office detective’s analysis of 17,175 Cactus Towing bills from June 2003 to March 2005 found $107,468 in fees that were overcharged or charged for services not allowed under the state Department of Public Service East Valley contract.

Records analyzed by detectives came from hard drives seized by deputies during a March 2005 raid at the company’s Mesa location. The DPS had warned Cactus about overcharges after a 2002 audit.

The fraud investigation focused on allegations by former employees and associates that the company used police towing contracts to gouge car owners by tacking on illegal charges, keeping a second set of billing records to mask illegal charges and defrauding insurance firms.

Those records are part of a second set released by the Sheriff’s Office, including six binders containing hundreds of pages of documents. They included interviews by detectives and an analysis of the company’s records.

Kent Nicholas, Cactus’ attorney, declined comment, saying he has not seen the records.

The report has been sent to the Arizona Attorney General’s Office for review.

Cactus, one of the largest towing companies in the state, was sold in June to Phoenix-based Rush Auto Recyclers. It operates the company under a new name, All-City Towing, with locations in Mesa, Chandler and Phoenix.

Copyright 2006 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

From This Issue

Insurance Journal West December 11, 2006
December 11, 2006
Insurance Journal West Magazine

2006 Program Directory, Vol. II

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