Tag: Fraud

Spotting the red flags of workers comp fraud

Spotting the red flags of workers comp fraud

PHILADELPHIA — The red flags indicating potential workers compensation fraud are evolving, and employers and workers comp insurers must be aware of these new indicators, especially the nature of the injuries.
Pennsylvania’s workers compensation law is designed to be remedial in nature, meaning whenever there is an inequity, it is construed in favor of the injured worker, said Niki Ingram, Philadelphia-based director of the law firm’s workers compensation department.
And that is why we are on a not so level playing field when we go into the courtroom representing insurers.” The traditional red flags are still relevant, including length of employment in terms of new hires claiming injuries or alleged injuries that occur immediately before or following a vacation, retirement or layoff, Ms. Ingram said.
Adjusters should always make sure they get the injured worker’s medical records because they will give a more accurate indication of when the injury actually occurred, she said.
“I think the one instance that drives every employer and carrier crazy is the person who just starts the job and then sustains an injury and is out for two or three years,” Ms. Ingram said.
But those are cases where you should immediately put your antenna up.” Disgruntled employees are also a traditional red flag for workers comp fraud, according to the lawyers.
Two days later, she slipped and fell at work, landing on her shoulders, alleging bilateral shoulder tears.
“This is how brazen a disgruntled employee could be … but in our system, I could have lost that case just as easily as I won if the judge decided to accept the claimant’s doctor as more credible than our doctor,” he said.
“Analytics rules now,” she said.
It rules in insurance.

Hobe Sound man indicted on federal fraud charges
Social Security Disability

Hobe Sound man indicted on federal fraud charges

People can call Treasure Coast Crime Stoppers to leave anonymous tips.
Wochit FORT PIERCE — A federal grand jury indicted a Hobe Sound man on charges including tax evasion, mail fraud and theft of government funds in connection with fraudulent disability payments, according to the U.S. Department of Justice.
The indictment against Arthur John Kranz, a doctor who specialized in psychiatry, was unsealed Thursday.
The application was approved.
Kranz was supposed to notify the Social Security Administration if he went back to work.
A Justice Department news release states Kranz worked as a psychiatrist in Pennsylvania between 2006 and 2013, earning more than $1.6 million that wasn’t reported to the Social Security Administration or the insurance company.
More: ‘Gamblers’ charged with fraud in connection with thefts from several arcades in Indian River County Kranz also is accused of trying to conceal his income from the Social Security Administration and the Internal Revenue Service.
Kranz is accused of getting more than $700,000 in fraudulent disability payments from the Social Security Administration and the insurance company.
In all, Kranz faces charges of tax evasion, mail fraud, wire fraud, theft of government funds and Social Security disability fraud.
More: Fort Pierce man one of hundreds charged in largest-ever elder fraud sweep by Justice Department

How Greeks end up in sham foreign jobs

How Greeks end up in sham foreign jobs

A large number of employment agencies have been hiring cheap labor across Europe.
But many Greeks have fallen victim to high expectations and fraudulent recruitment deals.
On-and-off jobs followed for months.
So prodded by another jobless friend, plus glossy ads promising a steady income of at least €1,300 euros ($1,600) a month, Varthimiadis signed up with a local job contractor recruiting blue-collar workers for a Japanese manufacturing plant in the Czech Republic.
The working conditions at the factory in Kadan, some 90 kilometers (55 miles) miles northwest of Prague, proved perfect, but the setup was a sham.
But others, mostly young Greeks facing a 50-percent unemployment rate among youths back home, stayed on — or at least tried to.
Across Europe, nearly 55,000 agencies recruit hundreds of thousands of workers each year for cheap manual labor and service-sector jobs.
While easing off another point last month, dipping to about 20 percent, it still remains nearly three times as high as the 8.8-percent EU average.
And that, unemployed people here say, will continue to keep pushing Greeks abroad in pursuit of jobs, potentially falling prey to dodgy recruiters. “I don’t care that I’d left,” said Neri, who has moved back in with her parents in Volos, central Greece.

Conn’s henchman pleads guilty to role in Social Security fraudster’s stunning escape
Social Security Disability

Conn’s henchman pleads guilty to role in Social Security fraudster’s stunning escape

A man who helped the orchestrator of the largest Social Security fraud in U.S. history cut off his ankle bracelet and flee the country pleaded guilty Friday to his role in the escape, admitting he’d spent months working to set it up.
Curtis Lee Wyatt had been the muscle for Eric C. Conn, a Kentucky lawyer who authorities say ran a fraud ring that totaled well more than $1 billion in bogus Social Security disability claims.
Wyatt, 48, assisted along the way, helping arrange the getaway car and making test-runs to see which border checkpoint would be the easiest for his boss to escape through on his journey out of the U.S. Wyatt also arranged for Conn to have a Faraday bag — the device that allowed him to shield his ankle bracelet when he cut it off, this avoiding detection by the monitoring service.
While Wyatt was charged with — and is pleading guilty to — his role in the Conn escape, Sarah Carver and Jennifer Griffith, the whistleblowers who exposed the massive disability fraud, say it’s just the tip of his criminal activity.
Carver, hoping to catch her breaking telework rules.
Carver and Ms. Griffith said Wyatt should have faced charges for that stalking as well as for the Conn escape.
“However, the DOJ failed to ever charge Wyatt,” Ms.
Carver said.
Authorities finally caught up to him in December at a Pizza hut in Honduras, and he was returned to the U.S. to face his 12-year sentence for the Social Security fraud.
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Calif. fraud report chronicles provider suspensions, illegitimate liens

Calif. fraud report chronicles provider suspensions, illegitimate liens

Since reforms took effect last year, the California Department of Industrial Relations has suspended 227 medical providers from treating injured workers and has dismissed 292,000 illegitimate liens filed by or on behalf of criminally charged providers, with claims valued at over $2.5 billion, the department announced Monday.
The state’s progress report on anti-fraud efforts since the state enacted workers compensation reforms put the focus on two pieces of legislation that aimed to stop fraud at the provider level.
The new laws that went into effect in 2017 were S.B.
1160, which requires the department to automatically stay liens belonging to providers who have been indicted or charged with crimes until the disposition of criminal proceedings, and A.B.
1244, which requires the workers compensation division’s director to suspend any medical provider, physician or practitioner from participating in the workers compensation system when convicted of fraud.
“(The department’s) anti-fraud efforts have allowed us to remove fraudulent providers and their claims for payment from the system, with the aim to improve services and reduce premium costs,” Director Christine Baker said in a press statement.
“Our fraud prevention work also involves identifying fraudulent activity through data analytics and defending anti-fraud laws in court.”

Montgomery couple convicted of Social Security, food stamps fraud

Montgomery couple convicted of Social Security, food stamps fraud

Montgomery Police Department data on criminal offenses in January 2018.
Wochit A Social Security office employee and her husband, both Montgomery residents, were convicted of fraud and witness tampering at the Federal Courthouse in Montgomery on Thursday.
More: The great divide: ‘Redlining’ kept neighborhoods separate, unequal “The trial evidence showed that the Palmers lied about their incomes and living arrangements for the purposes of fraudulently obtaining Social Security benefits on behalf of Nakia Palmer’s minor son,” the release states.
In total, the couple received $25,000 in improper benefits, money that the trial found was spent on a new vehicle.
Nakia Palmer was convicted of mail fraud, theft of government property, Social Security benefit fraud and food stamp fraud.
“Government benefit programs exist to ensure that those in need do not go without the necessities of life,” said United States Attorney Louis V. Franklin.
“The Palmers abused the system not out of need, but to maintain their lifestyles.
In carrying out their greedy scheme, the Palmers apparently thought that they were above the law.
I hope that this verdict sends the message that the theft of taxpayers’ dollars will not go unpunished.” A sentencing date has not yet been set.
The Palmers face fines and maximum sentences of 20 years’ imprisonment.

Ohio convicts three for workers compensation fraud

Ohio convicts three for workers compensation fraud

A funeral home worker and two cleaning company owners owe the Ohio Bureau of Workers’ Compensation a total of $30,000 after pleading guilty to workers compensation fraud or related charges in January.
The bureau said Friday that investigators found Columbus, Ohio-based Oran Lewis worked for two funeral homes as a funeral procession escort while collecting injured worker benefits; Mr. Lewis must pay $10,442 in restitution to the bureau.
In addition, Hudson, Ohio-based Amanda Joy Klapp was found to be operating her business, Amanda Joy Cleaning Co.
L.L.C., without workers comp coverage and must pay $14,000 in restitution to the bureau; and Columbus-based Robert Settlemoir was found to be operating Pro Clean Carpet and Upholstery without workers comp coverage and must pay restitution of $5,482.
“The money we recover from people trying to cheat our system will go where it rightfully belongs, taking care of injured workers and helping employers create safer workplaces across this state,” said Jim Wernecke, Columbus-based director of the bureau’s special investigations department.

Wayne couple charged in $4 million food stamp fraud at Paterson store

Wayne couple charged in $4 million food stamp fraud at Paterson store

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John C. Ensslin A Wayne couple was accused of illegally exchanging more than $4 million in food stamps for cash at a Paterson store during a three-year period, authorities charged on Monday.
Ibrahim Zughbi, 64, previously owned Neighborhood Supermarket in Paterson before it became Jamaica Meat Market but was disqualified in 2011 from involvement in food stamp, or SNAP, operations due to violations, according to the U.S. Attorney’s Office.
Zughbi and his wife Miriam Zughbi, 59, then became managers of the rebranded Jamaica Meat Market, despite the new owner claiming Ibrahim Zughbi would have no involvement in the business or its participation in SNAP, the U.S. Attorney’s Office stated.
Passaic County: Diaz blazes trail as first Hispanic female to serve as Passaic chief presiding judge Participating stores can exchange SNAP benefits for food, but not for cash.
From 2014 to 2017, the Zughbis were accused of exchanging more than $4 million in SNAP benefits for cash.
The high number of SNAP redemption at Jamaica Food Market appeared suspicious to authorities, but a confidential source, at the direction of law enforcement, completed 16 SNAP benefit for cash transactions at the store, according to the U.S. Attorney’s Office.
Ibrahim Zughbi was also charged with money laundering after the bank account of Jamaica Meat Market showed payments of more than $471,000 to him and various family members, the U.S. Attorney’s Office stated.
Email: jongsma@northjersey.com

Funeral home worker convicted of felony comp fraud

Funeral home worker convicted of felony comp fraud

An Ohio man must reimburse the Ohio Bureau of Workers Compensation more than $10,400 after pleading guilty to workers comp fraud Wednesday in a Columbus courtroom.
Bureau investigators conducted surveillance and collected evidence proving Columbus resident Oran Lewis, 66, worked for two different funeral homes in 2015 while collecting disability benefits from the bureau.
Mr. Lewis was injured in 2014 while working as a motorcycle escort for funeral processions, the bureau said Friday in a statement.
Mr. Lewis confessed and cooperated with the bureau.
A Franklin County Court of Common Pleas judge also sentenced Mr. Lewis to 180 days in jail and one year of probation for the fifth-degree felony, according to the statement.
“It doesn’t matter if you’re driving a vehicle or doing hard labor, it’s against the law to collect disability benefits from BWC when you’re also working and making a living,” Jim Wernecke, Columbus-based director of BWC’s special investigations department said in a statement.
“What’s more, we’re not talking about a one-time incident or occasional odd job here and there.
We found Mr. Lewis performing this service 29 times between May and October of 2015.”

Cleaning company owner pleads guilty to workers comp fraud

Cleaning company owner pleads guilty to workers comp fraud

The Ohio Bureau of Workers Compensation on Friday said the owner of a Hudson, Ohio-based cleaning business must serve 30 days under house arrest and pay $14,000 in restitution to the bureau after pleading guilty to workers comp fraud.
Amanda Joy Klapp, owner of Amanda Joy’s Cleaning Co., has had employees since 2013 but didn’t secure Ohio BWC coverage until 2015, intentionally underreporting payroll to avoid paying a higher premium.
She attempted to take out a new policy using her husband’s name to avoid paying the balance owed on her original policy after she stopped paying premiums and the policy lapsed, according the bureau’s special investigations department.
Ms. Klapp pleaded guilty on Jan. 9 to three first-degree misdemeanor counts of workers comp fraud in Stow Municipal Court in Summit County, Ohio.
She was fined $500 on each count.
Ms. Klapp must also bring her BWC coverage into compliance within 30 days and pay $750 in fines, the bureau said in a statement.