Ohio Agent Loses License for $200,000 Claim Payment Theft

Ohio Insurance Director Ann Womer Benjamin announced that insurance agent Steven Goodyear agreed to the revocation of his insurance license, effective immediately.

Goodyear signed a department consent order in which he reportedly admitted that he misappropriated $200,279.43 that was intended to pay medical claims for Perry County's self-insured health benefits plan. From November 1995 to June 1999, Goodyear, acting as Perry County's health insurance agent reportedly failed to have Perry County's account fully credited for payment of the health insurance premiums after having received checks of $80,000 and $120,279.43.

In the Perry County Court of Common Pleas, Goodyear pled no contest and was found guilty in open court on one count of felony theft. Goodyear also made partial restitution and is expected to pay an additional sum before he is sentenced at a later date.

Iowa Agent Gets 4 Years for Securities Fraud

A Marion, Iowa, insurance agent was sentenced to four years in prison for selling fraudulent securities, according to The Marion Star.

Paul L. Edwards, 68, received three years for reportedly engaging in a pattern of corrupt activity and one year for 27 securities offenses. Prosecutors said Edwards had sold $400,000 in promissory notes to area investors.

Edwards reportedly told the investors the notes were insured and were fool-proof, but they lost all of their money.

N.D. Man Gets 1 Year for Workers' Comp Fraud

A Berthold, N.D., man was sentenced to serve a year in the Ward County Jail and ordered to pay $5,618 in fines and restitution after pleading guilty to charges of filing false workers' compensation claims, according to the North Dakota Department of Insurance.

William Jones, 48, was sentenced Nov. 14 by District Court Judge Robert Holte to serve one year in the Ward County Jail with the one year suspended for a period of one year.

Jones will be on unsupervised probation for a period of a year, conditioned on Jones paying Workforce Safety & Insurance $5,243 in restitution and $375 in fines and fees to the court.

Charges were originally filed against Jones by Workforce Safety & Insurance in February 2002, with the warrant served on Jones in June of this year.

In the original complaint, Workforce Safety & Insurance determined that Jones had "willfully made false statements" on his Injured Worker Status Reports and willfully made false statements regarding his physical abilities or work abilities and income to WSI and medical care providers. His workers' compensation benefits were terminated in December 2001 and a complaint was filed in Ward County District Court in February of 2002. WSI was tipped off about Jones through the fraud hotline. Anyone wishing to report suspected workers' compensation fraud may call (800) 243-3331 or visit www.workforcesafety.com.

Kan. Fraud Unit Takes On Battle Against Crime

The Kansas Department of Insurance's new fraud unit announced its first prosecution. Acting in concert with the attorney general and Douglas County District Attorney Christine Kenney, the Unit has filed a 14-count criminal complaint against Rhonda Wilder.

The complaint charges Wilder violated the Fraudulent Insurance Act, as well as the statutes that prohibit forgery and making false information in connection with the sale of hundreds of thousands of dollars worth of annuities.

It should be remembered, the department noted in a statement, that the charges are accusations and that the defendant is presumed innocent unless proven guilty. The new fraud unit will be part of the department's legal division. With the creation of the Fraud Unit, Kansas Commissioner Sandy Praeger has restructured positions in the department to hopefully save money this year and in years to come by putting a dent in illegal schemes.

Bob Claus has been hired as the Fraud Unit Staff Attorney. Claus previously served as Montgomery County attorney and as the deputy attorney general of the Attorney General's Office Criminal Division. Ted Clark has been hired as the chief fraud investigator. Clark was a special agent with the Kansas Bureau of Investigation.

In order to give the Fraud Unit the authority it needs to prosecute insurance fraud criminals, Kansas Attorney General Phil Kline has appointed Claus to the position of special assistant attorney General. This will empower Claus to prosecute criminals throughout the state.

In addition, Attorney General Kline gave similar appointments to the other six lawyers in the department's legal division: John W. Campbell, Hsingkan Chiang, Brenda Clary, Keri Kish, Deletria Nash and Linda Sheppard. The lawyers, two of whom are former Assistant Ford County attorneys, will be able to assist the fraud unit when needed.

Some estimates show insurance fraud costs every family in America more than $1,000 per year. The sale of phony insurance and the reporting of false claims are crimes.

Poolman Orders Benefits Company to Stop Selling in N.D.

North Dakota Insurance Commissioner Jim Poolman issued a cease and desist order against My Smart Benefits Inc., an Indiana company that administers self-funded employee benefit plans for several employers in the state.

The commissioner has ordered My Smart Benefits Inc. to immediately stop selling new plans in North Dakota, but the order also requires the company to administer their existing plans.

The order arises in response to complaints of late payments or non-payment of benefits and concerns the department has about the company's financial and administrative competency to pay claims.

"Our job here is to make sure North Dakota consumers are being protected," Commissioner Poolman said.

"We will continue to investigate the actions and financial status of My Smart Benefits Inc. by working in cooperation with the Indiana Department of Insurance and the US Department of Labor. I will also ask the North Dakota Attorney General's office to investigate as well. We will do whatever we can to help consumers who are having trouble getting their claims paid."

The department started to receive complaints about My Smart Benefits last May, when the company was slow in paying some claims. The department continued to monitor the situation over the summer, but after recent contact with many My Smart Benefits customers it has been determined that My Smart Benefits does not have the financial capacity to properly service North Dakota consumers.

Poolman said, "Late payments can be a red-flag that a company is having financial difficulties. We also have reason to believe the company may have laid off most, if not all, of its employees. Obviously, we are very concerned that the company may have neither the proper staff, nor the financial ability to handle claims payments."