One of Florida’s Most Wanted for Insurance Fraud is Arrested in Maryland

James William Lloyd, Jr., who was part of an organized insurance fraud ring that carried out multiple staged vehicle accidents on Florida’s east coast, was recently arrested in Maryland. Before his arrest, the 42-year old held the dubious distinction of being on Florida’s “Top 10 Most Wanted for the Division of Insurance Fraud.”

According to a recent news story in the Naples Daily News, Lloyd’s elaborate scheme involved having crash participants report the accidents to their insurance companies and then attend treatment sessions at a local medical clinic. An employee at that clinic, who knew Lloyd, would then help process fraudulent bills for phony treatments. Investigators found that participants would pass along the phony bills for reimbursement by their insurance companies—collecting the insurance money, giving Lloyd a cut and pocketing the rest.

Maryland authorities wanted Lloyd in connection to a separate theft ring case and discovered that he was also wanted for crimes in Florida.

According to Maj. Glenn Hughes of the Florida Department of Financial Services, Lloyd often scoped out bars, clubs and restaurants to find participants. Targets were often out of work or down on their luck and needed some extra cash. “He promised if they participated in one of these staged crashes, which are usually very minor, they’d make some money.”

Hughes believes that although some legislative changes have made a dent in insurance fraud in recent years, they do not eliminate fraud. One such law on personal injury protection (“PIP”), which went into effect in 2013, gives a shorter time limit and a smaller coverage limit for those in crashes.

However, “Staged crashes aren’t identifiable to the insurance carriers,” Hughes said. “They look like any other crash really, they’ll have a police report, they’ll have billings from a chiropractic or physicians clinic, so from an insurance company standpoint they’re very hard to detect.”

“It’s a problem that’s not going away,” he said.

Comments Off

Filed under Insurance Fraud

Operation Sledgehammer Finds Three Chiropractors Guilty of PIP Fraud

A federal jury has convicted one West Palm Beach chiropractor and two Miami chiropractors for their roles in a massive staged automobile accident scheme, following a seven-week trial in U.S. District Court for the Southern District of Florida.

Using the U.S. mail in a scheme involving Personal Injury Protection (PIP) payments, defendants were found guilty of defrauding insurance companies through mail fraud and money laundering.

Kenneth Karow, 54, of West Palm Beach, Hermann J. Diehl, 44, of Miami, and Hal Mark Kreitman, 50, of Miami Beach were all convicted on multiple counts. Karow was sentenced to 11 years in prison, Diehl to nine years, and Kreitman to eight years for the fraud scheme that ran from October 2006 through December 2012.

The fraud was perpetuated in several ways across 21 chiropractic clinics, according to a release issued by the U.S. Attorneys’ Office for the Southern District of Florida. Key elements of the scheme are outlined below.

  1. Licensed chiropractors were recruited to serve as the “named owners” of chiropractic clinics, in circumvention of Florida licensing requirements, with others actually in financial control of the business.
  2. Recruiters were used to attract real or fake auto accident victims who were fraudulently treated at the chiropractic clinics for injuries.
  3. False chiropractic treatment claims where then billed to insurance carriers.
  4. No co-pays or deductibles were collected from the “patients,” and this fact was not disclosed to the insurance companies.
  5. The money received from this scheme was then used to pay recruiters and participants and to enrich members of the conspiracy.

The prosecution is the latest in a series of charges that have been part of a four year investigation into the massive conspiracy. The joint federal and state investigation, known as Operation Sledgehammer, has resulted in charges against 93 defendants for their roles in the organization. Of these 93 defendants, 57 have been charged by the U.S. Attorney’s Office, resulting in court-ordered restitution of more than $11 million to defrauded insurance companies.

Click on the link to read the full release.

Comments Off

Filed under Fla. Stat. 627.736 (2012), Insurance Fraud

Crooks Use Stolen IDs to Take Vehicles, Reports NICB

The National Insurance Crime Bureau (NICB) has noticed an uptick in the use of more sophisticated schemes to steal cars as new vehicle technology makes methods like hot-wiring almost obsolete. These findings highlight a growing trend in “financial fraud” auto theft.

Even though these vehicles are technically stolen by crooks, the methods they use for the theft—in legal terms—constitute financial fraud, the NICB explained in a news release. Consequently, these stolen vehicles are not counted as auto thefts, partially explaining a continual decline in auto theft crime statistics over the past two decades.

One such ploy involves the use of stolen forms of identification, such as fake drivers’ licenses and personal information stolen from identity theft victims. Stolen IDs are used to fraudulently lease or obtain loans to procure new vehicles. Once the crooks drive the vehicle off the lot, they never make scheduled payments. Often instead, these cars are re-sold to unsuspecting buyers after the scammers switch the Vehicle Identification Numbers (VINs).

Unfortunately for investigators, there is currently no central database that quantifies these crimes.

“Trying to put a number on these kinds of thefts is a challenge,” said NICB President and CEO Joe Wehrle. “It’s comparable to a hacker stealing IDs—you don’t know you’re a victim until it’s too late. Most of these thefts don’t show up in traditional crime reporting numbers and become financial losses for lenders, car rental companies and others. The result is millions of dollars added to the cost of doing business which is ultimately passed on to consumers.”

NICB advises consumers to frequently check their credit reports for signs that someone else is using their identity to take out new loans.

Because these types of “white collar” crimes have become more widespread, the NICB has launched a new series to draw attention to the growing trend in order to raise public awareness and thwart these types of auto thefts. Over the next few months, NICB will expose other new schemes that criminals are using to steal cars besides using stolen IDs.

Comments Off

Filed under Insurance Fraud

East Naples Woman Tries to Defraud Insurance Company over Spilled Coffee

An East Naples woman was arrested for phony medical and car wash bills after claiming Dunkin’ Donuts employees did not secure the lid on her coffee, causing it to spill on herself and in her car.

According to the Florida Division of Insurance Fraud, Jennifer Faye Sanders now faces charges of creating a false insurance claim and scheming to defraud.

A story on WINK News reported that Sanders submitted to Nationwide Insurance medical receipts totaling $200 for a doctor visit to treat her burns and an invoice with charges of $170 for the cleaning of her car. However, investigators discovered that Sanders had allegedly altered information on the medical receipt and took letterhead from the car wash establishment to create her own estimate of charges.

Nationwide Insurance referred Sanders’ claim to the Division of Insurance Fraud which arrested her. When she met with detectives, Sanders claimed that she didn’t mean to do anything wrong when she made the documents.

Comments Off

Filed under Insurance Fraud

Motorists Worry More about Other Drivers’ Distractions, Says Survey

Fingers point to the “other driver” as a safety risk due to texting and cell phone usage, according to the recently released 2014 Travelers Consumer Risk Index.

While 51 percent of respondents do acknowledge a potential risk in their own distracted driving habits, 89 percent worry about distractions exhibited by other drivers while they are on the road.

Distracted driving habits among drivers in the respondent’s household aged 16 to 21 were viewed as a cause for concern by only 21 percent of survey participants.

Coincidentally, Travelers notes that parents are responsible for 50 percent of cell phone calls involving a teen driver. In fact, the survey states that almost all parents surveyed (90 percent) admit to also engaging in at least one technical distraction themselves while driving.

As we reported in an August post titled “Texting Laws Appear to Reduce Traffic Fatalities,” 31 percent of U.S. drivers, aged 18-64 years, said that they had read or sent text or email messages while driving at least once in the 30 days prior based on 2011 data from the Centers for Disease Control and Prevention. That year saw 3,331 fatalities and 387,000 injuries involving distracted drivers.

Texting while driving results in a 23x increased likelihood of being involved in an accident, according to the survey.

Click on the link to read more about the 2014 Travelers Consumer Risk Index.

Comments Off

Filed under Uncategorized

Text Mining an Emerging Tool in Anti-Fraud Technology

Insurer use of anti-fraud technology is rising, according to a report released this month by the Coalition Against Insurance Fraud. The study reports that as of 2014 nearly all insurers (95 percent) said they use anti-fraud technology, compared to 88 percent in 2012.

Evidence that fraudulent activity is increasing bolsters the growing business need for technology-based solutions. More than half the insurers surveyed said that suspicious activity has risen over the last three years and that it flows through the entire claims cycle.

Fraud schemes today have not only increased in number, but shifted away from auto theft and more towards bodily injury and suspicious medical provider activity, according to the study. Insurers, needing to adapt to these tactical changes, are increasingly adopting advanced analytics to combat the evolving nature of fraudulent activity.

Advanced technological tools may help limit the rise in fraudulent activity, according to the report. The survey found that while 81 percent of insurers use basic technology tools, far fewer employ more advanced technology, such as link analysis (50 percent), predictive modeling (43 percent), or text mining (43 percent).

The most common challenge faced by 53 percent of insurers when considering implementing advanced anti-fraud technology is the lack of IT resources. Among other obstacles, SIU’s inability to process the large volume of potentially fraudulent claims was cited by 6 percent of insurers.

The increased presence of organized crime rings is a noteworthy development in the evolution of fraudulent activity. Text mining is one anti-fraud tool that can be utilized to expose these crime rings at the beginning of the claims process.

Text mining can connect information that is otherwise unstructured data buried in multiple, separate places, i.e., adjuster field notes, email, medical records, and police reports. By using text mining, insurers can explore this data to discover previously unknown concepts and patterns. For example, insurers use text mining to discover scripted comments in claims notes and call center logs, allowing them to notice incidences where multiple, allegedly unrelated, claimants say the same thing.

The study concludes that an anti-fraud strategy incorporating advanced technology and tools will result in a much higher fraud detection rate, thus ultimately cutting overall costs for insurers.

The report, titled “The State of Insurance Fraud Technology,” is published jointly by the Coalition Against Insurance Fraud and SAS. Click on the link to read more.

Comments Off

Filed under Insurance Fraud

Operation Sledgehammer Arrests another Staged Accident Recruit

Ricardo Pargas, 49, of West Palm Beach was arrested on Wednesday, September 24, 2014 for his participation in a staged auto crash ring, according to the Sun-Sentinel.

Acting on information from Allstate Insurance and the FBI, the Florida Division of Insurance Fraud discovered that Pargas and his wife had participated in a staged car crash while acting on directions from the fraud scheme’s ringleader, Alien Moya, 30, also of West Palm Beach. The couple, recruited by Moya, was paid $2,000 each for their part in the crash. As of this time it appears that Pargas’ wife has not been charged.

The crash at issue occurred on January 11, 2010 in West Palm Beach. Pargas and his wife were driving in a 2005 Ford pickup truck when they were intentionally rear-ended by a 1998 Chevrolet pickup driven by another participant in the scheme. A sheriff’s deputy responding to the scene reported that there were no injuries and that both drivers drove away.

Two days later, however, Pargas was being treated for injuries from the crash at Karow Chiropractic Center in West Palm Beach. The treatment center billed the insurance company $34,065, of which the company paid $19,386.25.

When interviewed by federal agents at his home on April 12, 2012, Pargas admitted to having been recruited by Moya to take part in the scheme. Pargas and his wife were instructed by Moya to undergo treatment at the Karow Chiropractic Center following the crash. They each visited the clinic twice a week, where they reportedly received massages and other treatments. Investigators pieced together their case against Pargas over two years, and he was booked into Palm Beach County Jail on Wednesday on a staged accident fraud charge.

Karow Chiropractic Center’s owner was convicted in April 2014 of conspiracy to commit mail fraud in connection with the staged crash.

Moya was arrested earlier this year by the FBI on separate federal charges of theft of an interstate shipment and selling stolen property after he and an accomplice were caught stealing the contents of a Walmart truck that they were hired to drive to a distribution center. At the time of the trucking theft in early February, Moya was out on bond while awaiting sentencing for his role in the Operation Sledgehammer staged accident fraud, according to an earlier Sun Sentinel article.

Comments Off

Filed under Insurance Fraud