View this article online: https://www.insurancejournal.com/magazines/mag-fraud/2005/12/04/151050.htm
A San Diego County Superior Court has sentenced Valley Center, Calif., businessman John Presley to three years formal probation and ordered him to pay $37,669 in restitution to California’s State Compensation Insurance Fund, which insures his business. Presley, 55, is the owner of JSP Construction Co., which provides ceiling installation.
The fraud was discovered through a State Fund audit of Presley’s business records after one of his employees reported a workplace injury. The audit uncovered records in which Presley reported he did not have any employees or payroll during the year audited. Additional audits found that Presley underreported payroll during a four-year period.
Calif. Doc Arrested in Scam
Ventura County, Calif., District Attorney Gregory Totten has announced that investigators from the District Attorney’s Office Bureau of Investigation has arrested Dr. Kent Pollock, 61, of Newbury Park, Calif., on a felony arrest warrant alleging the double billing of insurance companies for the treatment of individual patients.
Pollock was arrested on Oct. 18 without incident at his chiropractic office in Camarillo, Calif. The two-year investigation completed by the District Attorney’s Office Workers’ Compensation Fraud Unit and Automobile Insurance Fraud Unit included assistance from the National Insurance Crime Bureau.
The fraud scheme came to light after one of Pollock’s patients and the insurance claims adjuster reportedly discovered discrepancies in billing practices, including specific billings for days that the patient was never treated at the doctor’s office.
Further investigation reportedly revealed a similar pattern of fraudulent billing practices for other patients. The patients were being treated for a variety of injuries, including work-related injuries and personal accident injuries. The fraudulent billing practices took place between 1996 and 2003.
A five-count felony case has been filed against Pollock, including allegations of workers’ comp fraud and insurance fraud. Superior Court Judge Alan Steele authorized the arrest warrant and set bail at $50,000.
The case is pending arraignment. If convicted on all charges, Pollock faces a maximum sentence of nine years in state prison.
Former Calif. Broker Nabbed on Grand Theft Charges
A former Beverly Hills, Calif., insurance broker has been arrested and charged with one count of grand theft after an investigation by the California Department of Insurance (CDI) Investigation Division. CDI Investigators arrested Gregory Starrett Williams, 53. If convicted, he faces a maximum of three years in prison.
According to investigators, Williams, who owned Roger Starrett Williams Co., sold an errors and omissions policy to the owner of a local casting agency and subsequently collected $79,634.36 during a five-year period beginning in 1997. The owner of the casting firm received annual invoices and paid premiums to Williams’ Co., yet Williams allegedly never placed the coverage or forwarded premium payments to an insurance company.
Gregory Starrett Williams purchased the company in 1995, and the casting agency had been a client with the company for many years. In 2003, the casting agency’s office manager reviewed company files and discovered that there was no insurance coverage placed by Williams.
According to the office manager, she confronted Williams about the problem. Williams allegedly confessed to her that coverage was not placed and then promised to make payments to the casting agency. When he failed to make the payments, the office manager filed a complaint with the CDI, which initiated the investigation.
The Los Angeles County District Attorney’s Office is prosecuting the case and bail is set at $79,000.
Lawsuit Claims Disability Insurer Sought to Avoid Paying Claims
UnumProvident Corp., the nation’s largest disability insurer, has systematically sought ways to avoid paying claims to millions of California customers, a lawsuit claims.
The lawsuit filed in Superior Court by policyholders seeks class-action status. It comes less than one month after the company was ordered to pay $8 million to settle similar charges against the company by California insurance regulators.
The lawsuit seeks billions of dollars in premium refunds and damages for denied claims. The suit also names UnumProvident subsidiary Paul Revere Life Insurance Co.
The lead plaintiff in the case is former Berkeley, Calif., chiropractor Joan Hangarter, who won a unanimous $7.7 million federal jury award after she became disabled by tendinitis and Paul Revere denied her benefits.
Attorney Ray Bourhis said he expects the settlement with state officials to boost his case against Unum-Provident, which settled similar allegations with 48 other states last year.
UnumProvident spokeswoman Mary Clarke Guenther said the previous California settlement should foreclose the new claims.
“We find his latest complaint completely without merit and believe the recent settlement with California makes Bourhis’ charges moot,” she said.
Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Utah Pharmacy Owner Arrested on Suspicion of Fraudulent Billing
The owner of the Park City Pharmacy at The Clinic in Utah has been arrested on suspicion of fraudulently billing an insurance company for drugs that never were prescribed.
Thomas Evan Strebel, 60, was arrested for investigation of insurance fraud, witness tampering and bribery. He is being investigated for an alleged attempt to bribe a witness to not cooperate in the investigation.
The arrest was based on prescriptions involving one patient, but submissions for other people are being investigated, said FBI Special Agent Brent Robbins.
In January, a doctor contacted the Utah Division of Occupational and Professional Licensing after receiving a complaint from the insurance company regarding prescription practices involving one of her patients, according to a search warrant affidavit filed in 3rd District Court in Salt Lake City.
The company said the patient was being prescribed asthma medicine when she doesn’t suffer from the disease, the affidavit said. The doctor notified DOPL that the patient’s insurance company had been billed for multiple asthma drugs under her name that had not been prescribed.
In September, the insurance carrier provided billing information on claims allegedly not authorized by the doctor but submitted on behalf of the patient from Strebel’s pharmacy. The company paid nearly $27,000 for the claims.
Copyright 2005 Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
Calif. Couple, Brothers Nabbed
for Felony Auto Fraud Scam
A husband, his wife and another man have been arrested on felony auto insurance fraud charges following a California Department of Insurance Fraud Division investigation into the alleged theft of the couple’s automobile. A fourth suspect entered a guilty plea to related charges earlier this year.
Jose Paiz Uribe, 52, and his wife, Catherine Uribe, 45, both of Madera, Calif., were arrested after surrendering at the Madera County Sheriff’s Jail. Both were charged with two counts of felony insurance automobile fraud.
Leonel Cuevas, 60, was arrested on the same charges at his Madera residence.
His brother, Alfonso Cuevas, was sentenced to five years probation and 210 days in custody after pleading guilty June 23 to felony insurance fraud in the case.
California Department of Insurance investigators, assisted by the Madera County District Attorney’s Office, unraveled much of the case after Alfonso Cuevas was arrested on separate drug charges on June 23.
During the arrest, authorities asked Cuevas about a burned vehicle that the California Highway Patrol recovered earlier that day. Alfonso reportedly admitted to staging the automobile theft and burning of the 1998 Ford Expedition.
Alfonso reportedly told authorities that the Uribes owned the vehicle, and detailed their alleged involvement and scheme to fraudulently collect insurance money.
California Department of Insurance Investigators, as a result of Cuevas’ admissions, were able to arrest Jose and Catherine Uribe, as well as Leonel Cuevas.