Fraud Roundup

Calif. State Fund to receive $46,000

Imperial Valley, Calif., County Superior Court Judge Poli Flores has ordered an employee of an El Centro, Calif., hay exporter to pay $45,996 in restitution to the State Compensation Insurance Fund in a workers’ compensation insurance fraud case. Judge Flores also sentenced Jose D. Estrada, a machine operator at Kuhn Hay in El Centro, to five years formal probation, after he pleaded guilty to one count of felony workers’ compensation insurance fraud. Estrada earlier paid State Fund $18,000 as part of the total restitution. He was also ordered by the court to pay a $100 fine.

According to SCIF, Estrada reported an injury to his right ankle when he was struck from behind by a fork lift in April 2003. The fraud was later discovered by his employer when he saw Estrada walking without an orthopedic boot that he was supposed to be wearing for his injury. The employer called State Fund, which launched an investigation.

SCIF’s investigator filmed Estrada at his home and then driving to a physical therapy appointment. Estrada did not wear the orthopedic boot at home or on his drive. When he arrived at the physical therapist’s office, he put on the boot in the parking lot. He also used a cane when walking into the appointment. After the appointment, he took off the boot in the parking lot. State Fund concluded that Estrada was exaggerating his alleged ankle injury.

The Imperial County District Attorney’s Office charged Estrada with three counts of Insurance Code 1871.4 of which Estrada pleaded no contest to one count. The Department of Insurance (CDI) also assisted in the investigation.

Kuhn Hay, Estrada’s employer, was insured by State Fund from 2000 until 2004.

Ariz. man impersonates chiropractor

Agents from the Arizona Department of Insurance (ADOI) Investigations Division have arrested Mario Martinez for impersonating a chiropractor and fraudulently billing insurance companies for chiropractic treatment. Martinez is the owner of Natural Solutions Chiropractic and Wellness Center located in Chandler, Ariz.

According to ADOI, its investigators received information from a major auto insurance company that Martinez was submitting claims for chiropractic services without a license to practice chiropractic medicine. Martinez allegedly treated patients for injuries sustained in automobile accidents and billed insurance companies for the treatment. When the insurance company investigated the claims and reported their findings to ADOI for further investigation, Martinez admitted he was not licensed as a chiropractor in Arizona yet had been treating patients since at least Oct. 2006.

Authorities booked Martinez into the Maricopa County Jail and charged him with numerous counts of insurance fraud as well as, practicing chiropractic medicine without a license and using the title of chiropractic doctor without a license.

The Arizona Board of Chiropractic Examiners assisted ADOI investigators and is initiating its own investigation into Martinez’s activities.

Prepaid insurance scam targets elderly

California Insurance Commissioner Steve Poizner is alerting senior citizens of a pre-paid funeral scam that targeted the elderly in Southern California. A California Department of Insurance investigation found that the former owner of Valley Funeral Home in Murrieta sold “pre-need” burial insurance plans to senior citizens, then pocketed the premiums and left her elderly clients without funeral coverage.

Lee Ann Wyskiver, 55, was arrested at her home on April 5, 2007, by CDI investigators and the Escondido, Calif., Police Department. Wyskiver is charged with six felony counts including grand theft and financial elder abuse. She was booked into the Escondido jail, and bail was set at $50,000. The Riverside County District Attorney’s office is prosecuting the case.

According to investigators, between 1998 and 2004, Wyskiver collected nearly $20,000 from numerous elderly clients. Wyskiver allegedly led clients to believe that their policies had been placed with either Forethought Life Insurance Co. or Homesteader Life Insurance Co.

After receiving numerous complaints, the California Department of Consumers Affairs, Cemetery and Funeral Bureau initiated an investigation in 2005 and concluded that Wyskiver had committed gross acts of negligence and fraud.

Topics California Arizona