Doctor Files Fraudulent Workers' Comp Claims

The California Department of Insurance (CDI) arrested a Redding man on six felony counts of insurance fraud, six counts of grand theft and one count of conspiracy.

Richard W. Powell, M.D., 43, was arrested at his office in Redding and booked into the Shasta County Jail. Bail was set at $50,000.

Investigators discovered Powell was allegedly committing medical billing fraud while probing an unrelated fraudulent workers' compensation claim. Investigators executed a search warrant on Powell's office in Jan. 2001, and obtained evidence that revealed additional victims.

Powell allegedly hired a Licensed Vocational Nurse (LVN) and instructed the LVN to conduct one-on-one-therapy sessions with some of Powell's patients. He then billed these sessions to the patients' insurance company as if he were the one conducting the sessions. By law, LVN's are not qualified or permitted to conduct one-on-one-therapy sessions.

If convicted, Powell could face up to five years in state prison and/or a maximum fine of $50,000. The Shasta County District Attorney's Office is prosecuting the case.

LA Civilian Employee Convicted for Workers' Comp Fraud

A former Los Angeles County Sheriff's Department (LASD) civilian employee plead no contest to one count of felony insurance fraud for allegedly filing a false workers' comp claim.

Richard Montellano Argomaniz was arrested following an investigation by the CDI's Fraud Division that alleged he falsely claimed he was disabled from injuries he sustained to his back and right arm in a work-related accident in 1999.

The Los Angeles County Department of Human Resources hired a private investigation company to investigate the claim. A surveillance video showed Argomaniz working for STOVACT Inc. during the same periods he received benefits from his workers' comp claim.

Argomaniz testified in a deposition that he was presently a STOVACT employee, but asserted that he did not begin working until after he resigned his position with the county and ceased receiving workers' comp benefits.

Benefits received were in excess of $9,000 and included Temporary Total Disability (TTD), Industrial Accident earnings and salary continuation benefits; all from Los Angeles County and the LASD while Argomaniz was unable to work.

Argomaniz was sentenced to 100 hours of community service and ordered to pay restitution of $2,880 to Los Angeles County.

Long Beach Woman Surrenders to Fraud Charges

A Long Beach, Calif., woman surrendered on an outstanding warrant related to felony insurance fraud charges.

Yvonne Boyce allegedly slipped and fell while on the job in 1998 injuring her shoulder. She proceeded to receive workers' comp temporary total disability benefits for nearly a year. As a result of the fall, her condition was considered permanent with some disability restrictions. Because of her injury, she was eligible and obtained vocational rehabilitation maintenance allowance benefits for nine months in 1999.

Investigators from the CDI reported that Boyce was working at another employer while receiving the benefits, allegedly failing to disclose her employment status and ability to work.

She reportedly received in excess of $50,000 in workers' comp benefits.

Orange County Woman Pleads Guilty to Workers' Comp Fraud

Noel DeSota of Orange County was arrested by CDI fraud investigators and sentenced to serve 60 days in Orange County Jail, complete 120 hours of community service, three years probation, and pay a $200 court fine.

DeSota worked for Creative Business Concepts in Irvine in the spring of 1998 when she slipped and fell allegedly injuring her left hip, knee, back and neck. She was referred to a physician for treatment and later placed on temporary total disability according to her complaints and inability to return to normal work duties. Over the next several months, DeSota was referred to physical therapy treatments and a number of physicians to help alleviate her symptoms.

Later that year, DeSota hired a personal trainer from a gym to oversee a training routine for her. A couple months later, she joined a Jazzercise class and continued with the class for six months, while at the same time, allegedly informing her treating physicians she was unable to work as a result of pain any physical activity caused her.

In Feb. 1999, DeSota was videotaped at her gym training session and Jazzercise class. In a deposition later that year, she allegedly denied ever taking part in an aerobic-type class. CDI investigators displayed the videotape of DeSota's activities to her treating physicians, who following watching the videotape, claimed she made a material misrepresentation to them regarding her ability to return to her normal work requirements.

DeSota pled guilty to three counts of insurance fraud, which includes paying $70,000 restitution to Kemper Insurance Co.

No. Calif. Investigation Leads to Seven Arrests

An investigation involving Phil-Am Auto Body Shop in Oakland led to seven additional arrests in Alameda County. Domingo Combe, 80; Amadeo Comilang, 49; Nolasco Depadua, 45; Rodolfo Eleno, 60; Luthgarda Galvan, 44; Gracia Mangrobang, 65; and Ramon Nobela, 49; are charged with felony counts of grand theft, conspiracy and presenting fraudulent insurance claims.

Farmers Insurance Major Operations Unit, State Farm Insurance, Allstate Insurance and California State Automobile Association assisted CDI in this investigation.

The suspects were allegedly involved in separate collisions where they struck parked, unoccupied vehicles, then filed fictitious claims with Farmers Insurance.

Calif. Couple Surrenders on Fraud Charges

Ron Stahr, 40, of Hawthorne, Calif. and Michele Morlet, 24, of Whittier, Calif., surrendered themselves to CDI investigators in Los Angeles on arrest warrants which charged them with filing false insurance claims.

In the fall of 2001, Morlet and Stahr allegedly contacted an individual to photograph Morlet's license plate on his own personal high-performance vehicle. CDI investigators were contacted by the individual because of the unusual request. Morlet was sent the photographs by CDI investigators. Morlet later reported her car stolen and used the photographs to file a false insurance claim with State Farm Insurance.

Bail for both of the suspects is set at $30,000 each.

L.A. Agent Charged with Selling Phony Policies

A licensed agent and owner of First Class Insurance Agency, Robert Franklin, 35, of Los Angeles, was arrested and charged with two felony counts of grand theft.

Franklin allegedly sold fraudulent insurance policies to consumers and collected premiums without ever submitting the monies to the insurance companies, according to CDI investigators. He also allegedly issued phony ID cards. Franklin targeted African American consumers in the Los Angeles and Inglewood areas, and his activities left many victims without valid automobile liability coverage.

Franklin was booked into the Los Angeles County jail and his bail set at $40,000.

Vallejo, Calif. Broker Sold Fraudulent Policies

A search warrant was served by CDI investigators to former insurance broker Jimmie Earl Jackson, of Vallejo, Calif.

Jackson was operating Jaxon Insurance Services in Vallejo. CDI revoked Jackson's insurance license for allegedly accepting premium money from a client and failing to obtain a valid insurance policy. In April 2003, Vallejo Police Department discovered Jackson was continuing to sell insurance, which led to another investigation by Vallejo Police and CDI.

According to investigators, Jackson was paid over $700 for a homeowner policy in June 2002. Jackson cashed the client's check and provided an insurance certificate as proof of coverage. In Oct. 2002, over $50,000 dollars in damages was caused by a fire. The client was told that there was no insurance after contacting Jackson. The insurance certificate policy number was false and no insurer received any money from Jackson.