The 2014 insurance fraud hall of shame

2014 INSURANCE FRAUD

Insurance fraud is any act committed with the intent to obtain a fraudulent outcome from an insurance process. This may occur when a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due.

They represent the most brazen, vicious or klutziest insurance cons of the last year. Small wonder, they inflicted costly fakes and pains on consumers and insurers throughout the nation.

2014 Insurance Fraud cases presents “The Hall of Shame,” draws public attention to an $80-billion annual fraud spree that many consumers and policymakers think is a harmless and victimless crime. Most Americans are honest, but unacceptably large percentages tolerate fraud — a kind of outrage deficit disorder, research shows. The Hall of Shame presents true-life stories to convince more consumers that insurance fraud is deviant and intolerable behavior.

Storytelling is humankind’s oldest and most-effective form of communication. Our brains are biologically wired to think in narratives. Stories also are 20 times more likely to be remembered than hard facts.

Humans thus have fashioned stories to interpret and remember events since the first cave people sat around the campfire to talk about the day’s woolly mammoth hunt.

Fighting fraud is everyones top-of-mind concern, the 19th annual America’s Claims Event, June 17-19 in Austin offers multiple sessions and case studies to arm you with the latest strategies for your business.

Dr. Farid Fata | Detroit, Mich. Medicare Fraud

Seniors received painful and debilitating chemo therapy for cancer they never had. Cancer specialist Fata made $225 million in false Medicare claims. About half went for needless chemo and other cancer treatments. He deliberately misdiagnosed patients who were in remission or had no chance of surviving.

Medicare paid out more than $91 million, and Fata billed private insurers as well.

Fata gave one patient 155 chemo treatments over 2½ years — though the patient was cancer-free. Other patients were pumped with useless blood therapy and iron treatments. And one patient fell down and badly injured his head at the office. Yet Fata insisted that the patient receive his chemo before going to the ER.

Fata also faked anemia and fatigue diagnoses to justify giving patients dangerous levels of billable drugs. He faces up to 175 years in federal prison when sentenced.

CA Bay Area Psychologist Sentenced To 4 Months In Prison For Submitting Falsified Billing Records To Federal Workers’ Compensation Program

San Francisco, CA (WorkersCompensation.com) – Helena Weil was sentenced today to four months in prison and ordered to pay restitution of $496,101 related to her submission of billings to the federal Office of Workers’ Compensation Programs (OWCP), announced United States Attorney Melinda Haag and United States Postal Service-Office of Inspector General Special Agent in Charge Eileen Neff.

Weil, 64, of Kensington, California, pleaded guilty on July 2, 2014, to one count of 18 U.S.C. § 1519, which prohibits alteration or falsification of records.  Weil was a psychologist licensed to practice by the State of California and maintained a practice in the San Francisco Bay Area.  Weil treated numerous U.S. Postal Service and other U.S. Government employee-patients for which she was compensated through the OWCP, which administers Federal Employee Compensation Act programs.  Weil was required to submit bills truthfully setting forth (a) the Current Procedural Terminology (“CPT”) codes corresponding to the services she provided to the patients, (b) the names of the U.S. Postal Service and other U.S. Government employees for whom she was providing services; and (c) the date of those services.

Weil admitted that on various dates between approximately March 2006 and December 2009, she submitted bills to the OWCP related to in-person services she supposedly provided to patients while she either was away from California or was in training.  In all, Weil admitted that she submitted over 1,100 such billings for payment to the OWCP for dates on which she was traveling out of the state or was in training.  The amount of these billings exceeded $175,000.  Weil was charged in an information filed on May 23, 2014, and she formally waived indictment on May 29, 2014.  The information charged her with one count of alteration or falsification of records in violation of 18 U.S.C. § 1519.

Joseph Haddad | Bridgeport, Conn. Medical Insurance Fraud

Retribution crashed into personal-injury attorney Joseph Haddad for running a crime ring that stole millions of insurance dollars by giving useless and inflated treatment to crash victims his paid recruiters delivered.

He erected a large and complex network of doctors, chiropractors, diagnostic clinics and recruiters. Providers diagnosed victims, often without exams, then billed insurers for months of phantom or useless treatment. Runners typically appeared at police stations each day to buy police crash reports that identified the victims. The runners then badgered victims to sign up at Haddad’s office.

But Haddad fell hard once federal agents infiltrated his ring by acting as crash victims. One agent was billed for 11 chiro exams even though he only received four treatments. One of Haddad’s doctors, meanwhile, was operating with a suspended license.

Haddad was whacked with 51 months in federal prison and must repay $1.8 million.

Suburban lawyer pleads guilty in insurance fraud