Pennsylvania Fraud Stories

Message from the Executive Director

N O V E M B E R 2 0 1 5

Inside this issue:

Pennsylvania Insurance Fraud Prevention

Authority

Ralph Burnham

IFPA Executive Director

Public Relations 2

Know the Risks! 3

Workers’ Compensation

Fraud

3

Multiple Auto Fraud

Arrests

4

Bogus Auto Theft Claim 5

Body Shop Manager

Charged with 12 Counts

of Insurance Fraud &

Theft by Deception

6

Bogus Receipt Submit-

ted in Support of Fraud-

ulent Claim

7

ISO Search Reveals

Vandalism Claim is a

Duplicate of 2008 Claim

with Different Insurer

8

Failure to Disclose

Prior Accident on Appli-

cation for Auto Policy is

Fraud

9

Know the Penalties! 10

Mark Your Calendar! 16

Who to Call 17

Welcome to the November edition of our newsletter. I hope everyone had

a Happy Thanksgiving! In the midst of the holiday season, I thought it

would be an appropriate time to write about common fraudulent insurance

claims that SIUs and law enforcement encounter during this time of year.

With a still struggling economy and money tight, some people are looking

to make some quick cash in order to pay for holiday purchases. How many

times have we heard or seen this scenario..., “I was shopping at the mall,

put my purchases in the car and went back inside the mall to eat lunch.

When I returned to my car, I noticed that my car was broken into and all

of my purchases had been stolen.” In this scenario, it’s common for a claim

to then be submitted for high priced electronics, jewelry, and clothing, and

when asked how the items were purchased, the insured states they were purchased with cash. And

when asked for receipts as proof of purchases, they are unable to provide receipts as they claim the

receipts were in the shopping bags that were stolen. Upon inspection of the vehicle, it is determined

that there was no forced entry into the vehicle. The same scenario often plays out with renters’ insur-

ance policies as well, with an alleged break-in, no forced entry and high priced items allegedly stolen.

These are just a couple of examples of the types of fraud that may be committed during the weeks

leading up to and following the holiday season. Please keep an eye out for these scenarios as you re-

view your claim files.

The Bucks County District Attorney’s Office Insurance Fraud Section has a new website which has

an on-line referral form for insurance company personnel. The new website is:

http://www.buckscounty.org/government/RowOfficers/DistrictAttorney/InsuranceFraud

The IFPA, Del-Val IASIU and Greater Pittsburgh IASIU are in the planning stages of our Annual

Fraud Awareness Conference in Hershey, PA. This year’s conference will be held on Thursday, April

7th and Friday, April 8th. We will have a new format this year, with the conference beginning in the

morning of April 7th and finishing up after lunch on Friday, April 8th. Please save the dates on your

calendar.

Thanks again for all that you do in combating insurance fraud in Pennsylvania!

Merry Christmas and Happy Holidays!

Thomas Donahue

Executive Director

Public Relations

Page 2

Be on the look-out for new billboards popping up throughout

Central Pennsylvania!

Please visit us on Facebook at www.facebook.com/dontbeabut

Rumor has it that Weasy’s been seen hanging out at Penn State football

games, and there are pictures to prove it!

Page 3

Fraud Stories

The accounts of insurance fraud and insurance-related crimes that follow are drawn from Pennsylvania

law enforcement’s filed criminal complaints, press releases and newsletters. Criminal complaints dock-

eted may be viewed online, using the “OTN” shown in each of the following accounts, through the web

portal of Pennsylvania’s Unified Judicial System. Individuals shown charged with crimes are to be pre-

sumed innocent until they are proven guilty.

Know the Risks, Know the Penalties

On October 1, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Divi-

sion filed a Criminal Complaint charging 58 year-old Darrell B. Holland of Lansdowne, PA with Insurance

Fraud, Theft by Unlawful Taking, Theft by Deception-False Impression, Receiving Stolen Property and

Tamper with Public Record. According to the complaint, in October 2007, while employed by the United

States Postal Service as a Mark-Up Clerk, Holland had reported that he sustained a back injury while per-

forming his job duties and was placed on total/permanent disability and began receiving workers’ compen-

sation benefits. From September 13, 2013 through January 2, 2014, surveillance video footage of Holland

reportedly showed Holland performing activities inconsistent with his total disability to include traveling,

sitting, standing, walking, bending, lifting, shopping, carrying large bags of laundry and carrying cases of

soda. Holland further states on his Facebook page that he’s traveled extensively to various places to include

Dallas, San Diego, Louisiana, Los Angeles, Miami, Bahamas, Key West, North Carolina, Virginia, Wash-

ington DC, Princeton and Boston. According to the complaint, Holland’s treating doctor was interviewed

by the United States Office of Inspector General and after reviewing the surveillance footage of Holland

performing various functions, his treating doctor returned him back to work at a full capacity status. The

doctor further reportedly stated that Holland had exceeded his medical restrictions and that Holland,

based on the surveillance video footage, could have performed his job duties during the surveillance peri-

od. The complaint states that Holland had received $20,134 in workers’ compensation benefits during the

time of surveillance and when he was capable of performing his job duties. [OTN: T7089714]

On October 7, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Divi-

sion filed a Criminal Complaint charging 48 year-old Mildred McAveney of Glen Mills, PA with Insurance

Fraud, Attempted Theft by Deception-False Impression and Criminal Use of Communication Facility.

According to the complaint, McAveney was employed as a Resident Nurse by Freedom Village Brandywine

working in the independent senior living facility from December 3, 2012 to June 6, 2015. According to the

complaint, it had been alleged that McAveney wrote and forged a letter addressed to a Senior Casualty

Claims Specialist for SafeCo, stating that due to a serious vehicle accident in the month of December

2014, McAveney had lost a substantial amount of income from her employment, claiming that McAveney

had gone from working 30 – 40 hours per week to working only 16 hours per week at $22 per hour. The

letter alleged that due to McAveney’s only working 16 hours per week, she had sustained $12,144 in lost

wages. The investigation revealed that McAveney had not been out of work for any period of time and the

complaint reflects that McAveney later admitted that she had written the letter herself in an effort to re-

ceive $12,144 in lost wage compensation from Liberty Mutual Insurance Company. [OTN: T7114542]

On October 7, 2015, from a referral received from Southeast Pennsylvania Transportation Authority

(SEPTA), detectives of the Philadelphia District Attorney’s Insurance Fraud Unit arrested 54 year-old Jo-

seph Powell of Philadelphia, PA and charged him with Insurance Fraud, Attempted Theft by Deception

and False Alarms. According to the Criminal Complaint, on May 1, 2014, Powell was a passenger on a

SEPTA bus when a ceiling panel popped open and swung down over the rear seat of the bus. Surveillance

footage reportedly shows that Powell was seated in front of where the panel came down and at no point

had the panel struck Powell. Although surveillance footage on the SEPTA bus allegedly showed that Powell

Bogus Wage

Loss Claim

Know the Risks, Know the Penalties Page 4

had not been injured as he had claimed, Powell hired a personal injury attorney to represent him in filing a

personal injury claim against SEPTA and sought in excess of $16,000 for medical bills he alleged he incurred

between October 2014 and January 2015. [OTN: N9817194]

On October 7, 2015, from a referral received from Infinity Insurance Company, detectives of the Bucks

County District Attorney’s office filed two Criminal Complaints charging 39 year-old Jillann Pazdan of Bris-

tol, PA, and her father, 70 year-old Anthony P. Pazdan of Croydon, PA with Insurance Fraud, Conspiracy

and Criminal Attempt Theft by Deception-False Impression. According to the complaints, on April 21, 2014,

the defendants reported to Infinity Insurance Company that Jillann’s 2000 Nissan Sentra had been involved

in a two-vehicle accident in the parking lot of a Wawa. Both reportedly claimed that Anthony had been oper-

ating the Nissan at the time of the accident and that Jillann was a passenger in the vehicle. On April 22, 2014

during an interview, the driver of the other vehicle involved in the accident reportedly stated that Jillann was

operating the vehicle when she backed into his vehicle and that the only other passenger in her vehicle was a

small child. The investigation revealed that the policy holder of the Nissan was Anthony Pazdan and that

Jillann did not have a driver’s license and was listed as an excluded driver on the Infinity policy. According to

the complaint, on April 30, 2014, both defendants reportedly admitted that Jillann had been operating the

Nissan when the accident occurred. Infinity had not paid the Pazdans’ claim. [OTN: L9739402, L9739380]

On October 7, 2015, Office of Attorney General special agents filed a Criminal Complaint in Somerset

County charging 22 year-old Adam Franklin Lung of Boyton, PA with Insurance Fraud and Attempted Theft

by Deception. According to the complaint, on March 28, 2015 at 12:40 PM, Lung contacted Progressive

Insurance Company to add collision/comprehensive coverage to his existing policy. Lung again contacted

Progressive the same day at 1:34 PM to report that he had been involved in a one-vehicle accident. According

to a PA State Police Auto Accident Report, PA State Police were dispatched to Lung’s accident at 12:20 PM

and reportedly arrived on the scene at 12:37 PM. Lung later admitted that he added additional coverage to

his policy after the accident in the hopes that Progressive would pay for the damage to his vehicle; however,

Progressive did not pay the claim. [OTN: T7111300]

On October 9, 2015, detectives of the Allegheny County Police Department filed a Criminal Complaint

charging 45 year-old Timothy Andrew Klanica of Glenshaw, PA with Insurance Fraud. According to the com-

plaint, Klanica obtained a Nationwide Insurance auto policy on March 8, 2015 at 5:04 PM. Klanica’s prior

Nationwide policy had reportedly canceled on January 6, 2015. Klanica claimed he was involved in an acci-

dent on March 8, 2015 PM at 5:45 PM; however, a Shaler Township Police Crash Report stated officers had

been dispatched to the accident at 3:39 PM. Furthermore, Klanica’s vehicle had to be towed from the scene,

and according to the tow bill, Klanica’s vehicle was towed at 4:05 PM. According to the complaint, it was

alleged that Klanica was involved in an auto accident before he’d obtained the Nationwide auto policy on

March 8, 2015. [OTN: G7245906]

On October 9, 2015, Office of Attorney General special agents filed a Criminal Complaint in Cambria

County charging 55 year-old Brian Michael Buchko of Johnstown, PA with two counts of Insurance Fraud

and one count of Attempted Theft by Deception-False Impression. According to the complaint, Buchko ob-

tained an auto insurance policy with Safe Auto Insurance Company on November 21, 2014 at 6:47 PM. The

following day, Buchko filed a claim alleging that he was involved in a two-vehicle accident on November 21,

2014 at 7:30 PM; however, the driver of the other vehicle reportedly stated that the accident occurred at ap-

proximately 5:30 PM which was prior to Buchko obtaining the Safe Auto policy. According to the complaint,

damage to the other driver’s vehicle was $900. [OTN: T7124950]

Fraud Stories (Continued)

Fraudulent

Motor Vehicle

Insurance

Claims Lead to

Charges of

Insurance

Fraud

Know the Risks, Know the Penalties Page 5

On October 9, 2015, Office of Attorney General (OAG) special agents filed a Criminal Complaint charging 51

year-old Bonifacio Hernandez of Wilkes Barre, PA with Insurance Fraud, Attempted Theft by Deception-False

Impression and 12 counts of Forgery. According to the complaint, on September 4, 2014, Hernandez submitted

a claim to Allstate Insurance Company alleging that $14,000 worth of property was stolen from his residence

where he rented a room in the building from another tenant. Hernandez reportedly claimed that he had locked

his bedroom door and returned later that evening to find the door had been pried open and his belongings miss-

ing. Hernandez provided receipts in support of the stolen items which purported to be from purchases made

through Amazon.com. According to the complaint, Allstate had contracted Stumar Investigation to continue the

investigation of the defendant’s claim and it was revealed that the invoices were not valid nor were they con-

sistent with Amazon’s invoicing protocols. On July 27, 2015, during an interview with an OAG special agent,

Hernandez admitted that the receipts he provided in support of his claim were fraudulent. [OTN: T7124596]

On October 12, 2015, from a referral received from Nationwide Insurance Company, detectives of the Philadel-

phia District Attorney’s Insurance Fraud Unit arrested 27 year-old Jackqueline Tolbert of Wilmington, DE and

charged her with Insurance Fraud, Attempted Theft by Deception, Criminal Conspiracy, Unsworn Falsification

and False Reports. According to the Criminal Complaint, on May 11, 2014, Tolbert reported to the Philadelph-

ia Police Department that her 2013 Mitsubishi had been stolen. Insurance fraud detectives retrieved the Phila-

delphia Police Stolen Auto Report which stated that Tolbert’s vehicle had been stolen sometime between May

10, 2014 and May 11, 2014. According to the complaint, the investigation revealed that Tolbert had in fact giv-

en the vehicle to acquaintances because she could no longer maintain the payments, and subsequently filed a

fraudulent theft claim with the Philadelphia Police and Nationwide. [OTN: N9824161]

On October 13, 2015, detectives of the Allegheny County Police Department filed a Criminal Complaint charg-

ing 36 year-old Thomas Edward Shray, Jr. of Pittsburgh, PA with Insurance Fraud. According to the complaint,

Shray obtained a Permanent General auto insurance policy and claimed on August 13, 2015 that his 2012 Kia

Sorento had sustained key damage. The complaint states that detectives of the Allegheny Police had filed two

other complaints against Shray in August 2015 that reflect Shray had filed claims with State Farm and Safe Auto

for the same damage to the Sorento and had received claim funds totaling $5,982.41, but had not had the dam-

age repaired. According to the complaint, Shray reportedly admitted that the damage to the Sorento he was

reporting to Permanent General was the same damage in which he’d filed prior claims, but never had repaired

with the claim funds he received from State Farm and Safe Auto. [OTN: G7249362, G7203453, G7203490]

On October 16, 2015, Office of Attorney General special agents filed two Criminal Complaints in Lackawanna

County charging 44 year-old Dr. Rajaa Nebbari of Scranton, PA and 52 year-old Dr. Chethan V. Byadgi of Mil-

ford, PA each with Medicaid Fraud, Insurance Fraud, Theft by Deception, Criminal Attempt Theft by Decep-

tion and Prescription Not in Accordance with Treatment Principles. According to the Criminal Complaints, the

doctors were owners/employees of Scranton Urgent Care, and worked with another individual who was hired as

a Medical Assistant and later named “Suboxone Coordinator” in February 2012. According to the complaints,

the Suboxone Coordinator had no medical degree, but met with Suboxone patients and provided them with

prescriptions that she wrote on the prescription pads of Dr. Nebbari or Dr. Byadgi. It is alleged that the doctors

required the patients to pay cash for office visits, but also billed patients’ insurers. The complaint states that the

doctors opened Family Urgent Care as a new Suboxone clinic in 2013, and patients continued to be treated by

the Suboxone Coordinator, not by either doctor and that the Suboxone Coordinator continued writing Subox-

one prescriptions with the prescription pads of both doctors. Alleged fraudulent claims were made to the Medi-

cal Assistance Program, the Pennsylvania Department of Human Services, Medicare, Aetna, BCNEPA,

Geisinger and Highmark Insurance. [OTN: T7159305, T7158992]

Fraud Stories (Continued)

“...the investigation

revealed that Tolbert had

in fact given the vehicle

to acquaintances because

she could no longer

maintain the payments,

and subsequently filed a

fraudulent theft claim

with the Philadelphia

Police and Nationwide.”

On October 16, 2015, Office of Attorney General special agents filed a Criminal Complaint in Philadelphia

charging 47 year-old Kim Simone of Philadelphia, PA with Insurance Fraud and Criminal Attempt Theft by

Deception-False Impression. According to the complaint, Simone filed a slip-and-fall claim against a Phila-

delphia Walmart on February 8, 2013 claiming that she had slipped on a puddle of water while walking

down an aisle and suffered injuries as a result to her ankle, hip, neck and head. According to the complaint,

a Walmart employee who arrived within minutes of the supposed fall, and while Simone was still on the

floor, confirmed that there was no water or any other liquid on the floor. Furthermore, surveillance footage

reportedly shows that Simone did not fall, but that she deliberately lowered herself to the floor and then

rolled over onto her stomach where she remained until the Walmart employee arrived. Walmart did not

pay Simone’s claim. [OTN: N9828033]

On October 20, 2015, from a referral received from Farmers Insurance Company, detectives of the Phila-

delphia District Attorney’s Insurance Fraud Unit arrested 54 year-old Jeffrey Freni of Mantua, NJ and

charged him with 12 counts each of Insurance Fraud and Theft by Deception. According to the Criminal

Complaint, Alex’s Auto Body, a body shop managed by the defendant, accepted multiple payments from

Farmers Insurance Company for repairs that the body shop had not repaired. Insurance fraud detectives

reportedly met with special investigators from Farmers who related that they had examined 12 of their cus-

tomers’ vehicles after they were allegedly repaired at Alex’s Body Shop and found parts the insurance com-

pany paid for that were never installed, some damaged parts had never been repaired and filler was used to

make damaged areas appear as though they had been fixed. Further investigation revealed that the body

shop had received in excess of $25,000 for parts they never installed and labor they never performed. [OTN:

N9832874]

On October 21, 2015, detectives of the Lehigh County District Attorney’s office filed a Criminal Com-

plaint in Northampton County charging 30 year-old Shawn Steven Ackerman of Bethlehem, PA with Insur-

ance Fraud. According to the complaint, on February 12, 2015 at 6:02 PM, Ackerman was involved in a

motor vehicle accident while operating his 2003 Audi. Following the accident, Ackerman reportedly provid-

ed Bethlehem Police with a Progressive Insurance policy number as proof of insurance; however, the inves-

tigation revealed that Ackerman had not obtained a valid auto insurance policy until February 12, 2015 at

6:09 PM, just minutes after he had been involved in the crash. [OTN: T7120013]

On October 22, 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Crimi-

nal Complaint in Luzerne County charging 66 year-old Juan Santana with two counts each of Insurance

Fraud and Theft by Deception. According to the complaint, it is alleged that Santana stated on his applica-

tion for auto insurance with Erie Insurance Group that his primary address and garaging location of his

vehicle was that of Wilkes-Barre, PA when in fact, he is a resident of New York. The complaint states that

the defendant had filed an accident claim on March 12, 2015; however, the claim had not been paid by Erie

Insurance Group. According to the complaint, had Santana been forthcoming in regards to his residency,

he’d have paid an additional $2,009 in premiums. [OTN: T7170704]

On October 22, 2015, detectives of the Cumberland County District Attorney’s office filed a Criminal

Complaint charging 50 year-old Bryan Keith Kerekish of Shermans Dale, PA with Insurance Fraud, Crimi-

nal Attempt Theft by Deception-False Impression and Perjury. According to the complaint, Kerekish was

employed by the Commonwealth of Pennsylvania Department of Corrections and on December 29, 2011,

Kerekish reported to his supervisor he injured his lower back while manually pushing a “coal larry” to refill

a coal fired boiler with coal, and subsequently filed a workers’ compensation claim through CompServices,

Know the Risks, Know the Penalties Page 6

Fraud Stories (Continued)

Auto Body

Shop Manager

Charged with

12 Counts of

Insurance

Fraud & Theft

by Deception

Fraud Stories (Continued)

Inc., the Commonwealth’s third party administrator at the time. Reportedly, Kerekish’s workers’ compensa-

tion claim was denied as the investigation revealed that Kerekish had an extensive history of back issues, and

an independent medical review reportedly determined that the work-related injury Kerekish reported had not

caused significant trauma. [OTN: T7168943]

On October 26, 2015, Office of Attorney General special agents filed a Criminal Complaint in Lehigh Coun-

ty charging 30 year-old Amber Marie Barnes of Danielsville, PA with two counts of Insurance Fraud and one

count of Criminal Attempt Theft by Deception-False Impression. According to the complaint, Barnes was

listed as an insured driver on her boyfriend’s auto insurance policy with Progressive Insurance Company.

Progressive reportedly canceled the policy for non-payment, and Barnes contacted Progressive the following

morning to make a payment in order to have the policy reinstated. Subsequently on the same day, Progressive

reportedly received a phone call from an individual reporting that he had been in an accident with Barnes.

The driver of the other vehicle involved had reportedly also told the State Trooper who responded to the

scene that the accident occurred approximately 30 minutes before Barnes had reinstated the canceled policy.

According to the complaint, in a subsequent statement to Progressive, Barnes confirmed that the accident

occurred before she had the policy reinstated, and Progressive did not pay the claim. [OTN: T7180456]

On October 26, 2015, Office of Attorney General special agents filed a Criminal Complaint in Allegheny

County charging 42 year-old Carrie L. Baginski of Clinton, PA with Insurance Fraud Forgery and Criminal

Attempt Theft by Deception-False Impression. According to the complaint, Baginski filed a homeowner’s

claim with Travelers Insurance for odors entering her home after a neighbor passed away and the body re-

mained in the home for 7 – 10 days. Part of her claim alleged that she stayed at a hotel for 66 nights at a rate

of $120 per night – a total of $8,700. According to the complaint, the investigation revealed that the hotel

Baginski claimed she stayed at did not exist, and that she had actually stayed with her mother during this

time. Travelers reportedly has a maximum hotel allowance of $120 per day, however, Travelers would only

have paid $25 – $50 per day for staying with a family member. Reportedly, Baginski admitted to making the

receipt to obtain the maximum daily allowance from Travelers. [OTN: G7261214]

On October 26, 2015, detectives of the York County District Attorney’s office filed a Criminal Complaint

charging 38 year-old Jason J. Rodriguez of York Haven, PA with Insurance Fraud and Criminal Attempt Theft

by Deception-False Impression. According to the complaint, on July 15, 2015 at 4:55 PM, Rodriguez pur-

chased a Progressive Specialty Insurance auto insurance policy to insure his vehicle. The complaint alleges

that approximately 40 minutes prior to obtaining the Progressive policy, Rodriguez had been involved in a

two-vehicle accident on Interstate 83. The driver of the other vehicle involved reportedly photographed the

damage to his vehicle immediately after the crash and according to the photographs’ metadata, the photos

were taken at 4:17 PM. Damage to the other vehicle involved was estimated to be $1,205.22; however, Pro-

gressive did not pay the claim. [OTN: T7185382]

On October 26, 2015, from a referral received from GEICO Insurance Company, detectives of the Philadel-

phia District Attorney’s Insurance Fraud Unit arrested 28 year-old Jessica Santiago of Philadelphia, PA and

charged her with Insurance Fraud, Attempted Theft by Deception and False Reports. According to the Crimi-

nal Complaint, on December 8, 2012, Santiago reported to both the Philadelphia Police Department and

GEICO that her 2011 Dodge Charger had been stolen. Insurance fraud detectives reportedly retrieved the

Philadelphia Police Investigation Report which stated that Santiago’s vehicle had been stolen at approximate-

ly 3:30 AM on December 8, 2012. Insurance fraud detectives also reportedly retrieved a Philadelphia Police

Non-Reportable Accident Report that stated that Santiago’s vehicle had been involved in an auto accident

Know the Risks, Know the Penalties Page 7

“...in a subsequent

statement to Progressive,

Barnes confirmed that

the accident occurred

before she had the policy

reinstated, and

Progressive did not pay

the claim.”

just three hours prior to having been stolen. According to the complaint, GEICO had paid Santiago $13,000

for the loss of her vehicle; however, Santiago later admitted in a recorded statement to GEICO that her vehi-

cle had been in an accident, but that it had never been stolen as she had originally claimed. [OTN: N9840994]

On October 27, 2015, Office of Attorney General special agents filed a Criminal Complaint in McKean

County charging 31 year-old Joanna Marie Hendryx of Derrick City, PA with Insurance Fraud and Attempted

Theft by Deception-False Impression. According to the complaint, on or about April 9, 2015, Hendryx filed a

claim with GEICO Insurance for a single-vehicle accident with a deer to which the claim was denied as she

only had liability coverage at the time. The complaint reflects that on that same date, Hendryx obtained a new

auto policy with Progressive Insurance, and on April 12, 2015, submitted a claim stating that she was in-

volved in a single-vehicle crash with a deer on April 11, 2015. According to the complaint, Hendryx reportedly

admitted to agents that the accident occurred before she obtained additional coverage and that she provided

false information to Progressive in the hopes of having the damage to her vehicle paid for. Progressive did not

pay the claim. [OTN: T7192662]

On October 27, 2015, detectives of the Lehigh County District Attorney’s office filed a Criminal Complaint

charging 38 year-old Maribeth Jean Allen of Coopersburg, PA with Insurance Fraud. According to the com-

plaint, on May 2, 2015 at 9:03 PM, Allen was involved in a motor vehicle accident while operating her 2003

Chevrolet. Allen reportedly had not renewed her Progressive Insurance auto policy until 10:13 PM that same

day; however, when Allen reported the accident to Progressive, she reportedly misrepresented the actual time

of the accident to appear as though it happened after she renewed her policy. [OTN: L9783281]

On October 27, 2015, Office of Attorney General special agents filed a Criminal Complaint in Beaver County

charging 35 year-old Joshua J. Verner of Ambridge, PA with Insurance Fraud and Attempted Theft by Decep-

tion-False Impression. According to the complaint, on or about February 8, 2015, Verner obtained an auto

insurance policy with GEICO Insurance, and subsequently on February 12, 2015 submitted a claim reporting

that he was involved in a single-vehicle crash with a deer earlier that day. According to the complaint, Verner’s

ex-girlfriend reported to investigators that Verner had texted her a photograph of the damage that resulted

from the accident and that the accident had actually occurred on February 6, 2015, before Verner had ob-

tained the GEICO policy. The complaint states that Verner later confessed to special agents that the accident

occurred before he obtained insurance with GEICO. GEICO had not paid the claim. [OTN: T7189711]

On October 27, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 34 year-

old Michael Thompson of Philadelphia, PA with Insurance Fraud and Attempted Theft by Deception-False

Impression. According to the complaint, on May 15, 2013, Thompson reported to Esurance Insurance Ser-

vices Inc. that his 1999 Volkswagen Passat had been vandalized that same day sometime between 7:30 AM and

7:00 PM. On May 20, 2013, Esurance investigators conducted an ISO search that revealed that the same vehi-

cle had prior claims of vandalism that were unrepaired from a different owner and a different insurance com-

pany from 2008. Reportedly, upon reviewing photographs of the prior claim, investigators were able to deter-

mine that the damage to the Passat in which Thompson was claiming had occurred on May 15 th was the same

damage that was reported in the 2008 claim. Thompson reportedly withdrew his claim. According to the com-

plaint, special agents spoke with Thompson in July 2015 and at that time the complaint states that Thompson

provided a written and signed statement in which he admitted that he submitted an insurance claim for his

1999 Volkswagen Passat for damages that occurred prior to him owning the vehicle. According to the com-

plaint, the final estimate to repair the Passat was $2,020.24, less a $500 deductible. Esurance did not pay

Thompson’s claim. [OTN: N9842033]

Fraud Stories (Continued)

Page 8 Know the Risks, Know the Penalties

“On May 20, 2013,

Esurance investigators

conducted an ISO search

that revealed that the

same vehicle had prior

claims of vandalism that

were unrepaired from a

different owner and a

different insurance

company from 2008.”

“...the defendants

confessed to making false

statements to Safe Auto

in filing the March 2015

claim in an attempt to

have the prior damage

paid for.”

Fraud Stories (Continued)

On October 28, 2015, Office of Attorney General special agents filed two Criminal Complaints in Mercer

County charging 42 year-old Leaha M. Taylor of Farrell, PA with three counts of Insurance Fraud and one

count of Theft by Deception-False Impression. Also charged was 52 year-old John D. Leali of Sharon, PA with

two counts of Insurance Fraud and one count of Criminal Attempt Theft by Deception-False Impression.

According to the complaints, on or around March 3, 2015 at 10:59 AM, Taylor obtained an auto insurance

policy with Safe Auto Insurance Company to insure a 2013 Hyundai Elantra, and stated on the application

that the vehicle currently had no damage. On March 9, 2015, Leali filed a claim with Safe Auto stating that

he had been involved in an accident while operating the Elantra. During the course of the investigation, an

ISO check reportedly uncovered that the Elantra had been involved in an accident in January 2015 while

being operated by an individual later identified as Taylor’s boyfriend and insured by GEICO. That claim had

been denied due to lack of coverage. The driver of the other vehicle involved in the January 2015 accident

had reportedly taken photos and submitted them as part of the claim, and when those pictures were com-

pared to the alleged March 2015 accident, the damage was exactly the same. Taylor’s boyfriend reportedly

admitted that he’d been driving the vehicle at the time of the January accident, and that the vehicle had sus-

tained approximately $5,243.46 in damage. According to the complaint, the damage that resulted from the

January accident was never repaired, and the defendants confessed to making false statements to Safe Auto in

filing the March 2015 claim in the attempt to have the prior damage paid for. [OTN: T7193174, T7194622]

On October 28, 2015, detectives of the Northeast Pennsylvania Insurance Fraud Task Force filed a Criminal

Complaint charging 27 year-old Howard George Rau of Duryea, PA with Insurance Fraud. According to the

complaint, it was alleged that Rau was uninsured when he was involved in a hit-and-run accident when he hit

a parked vehicle on March 9, 2015 at approximately 4:54 PM. The complaint reflects that Rau had not ob-

tained a valid auto insurance policy with Safe Auto Insurance Company until 6:36 PM on March 9, 2015,

after he’d already been involved in the hit-and-run earlier that same day, and that Rau had not disclosed the

hit-and-run to Safe Auto during the application process. [OTN: T7194902]

On October 29, 2015, Office of Attorney General special agents filed a Criminal Complaint charging 36 year-

old Amy S. Millward of Cranberry Township, PA with two counts each of Insurance Fraud and Attempted

Theft by Deception. According to the complaint, Millward obtained auto insurance policies on March 24,

2015 from The General and Safe Auto Insurance Companies. Subsequently, after obtaining the policies,

Millward filed a claim with both companies claiming that she had hit a deer as she was driving home from

work. Millward submitted digital photographs she had taken of the damage at the scene to both companies in

support of her claim, and according to the complaint, the data stored from the photographs that Millward

submitted revealed that the accident occurred prior to Millward obtaining the two policies. Millward report-

edly later admitted that she misrepresented the accident time during the claim process in an attempt to obtain

approximately $3,600 for her vehicle’s front-end damage. Neither company paid either of Millward’s claims.

[OTN: T7197466]

On October 30, 2015, detectives of the Delaware County District Attorney’s Criminal Investigation Division

filed a Criminal Complaint charging 37 year-old Kathleen Curtis of Springfield, PA with Insurance Fraud,

Attempted Theft by Deception-False Impression and Criminal Use of Communication Facility. According to

the complaint, on October 21, 2014 at 2:46 PM, Curtis obtained an insurance policy with Progressive Ad-

vanced Insurance to insure her 2003 Nissan Sentra. Subsequently, at 3:28 PM, Curtis contacted Progressive

to report that she had been involved in an accident just 15 minutes after obtaining the new policy. The com-

plaint states that a Philadelphia Non-Reportable Accident Report states that Curtis’ accident had occurred on

Know the Risks, Know the Penalties Page 9

Fraud Stories (Continued)

October 10, 2014 at 2:15 PM, sometime after her prior insurance policy of GEICO Insurance had expired.

Progressive did not pay Curtis’ claim. [OTN: T6949132]

On October 30, 2015, detectives of the Lehigh County District Attorney’s office filed a Criminal Complaint

charging 26 year-old Francheska Ortiz-Torres of Phillipsburg, NJ with Insurance Fraud. According to the com-

plaint, the defendant allegedly registered three vehicles and on application, provided an Easton, PA address as

her primary address and garaging location of each vehicle. It is alleged that the defendant resides in New Jer-

sey, not Pennsylvania, and that she provided false information on applications for her vehicles’ registrations

with PennDOT and on application for insurance with Safe Auto Insurance Company. [OTN: T7202344]

On October 30, 2013, Office of Attorney special agents filed a Criminal Complaint in Lawrence County

charging 27 year-old Amber Ann Loutzenhiser of Beaver, PA with Insurance Fraud and Acquire or Obtain

Possession of Controlled Substance. According to the complaint, Loutzenhiser was a registered nurse at Jame-

son Hospital in New Castle, PA. It was alleged that Loutzenhiser fraudulently recorded electronically and on

patient charts that on June 21, 2015 she administered Dilaudid through IV four separate times to each of two

patients. The complaint alleges that Loutzenhiser had not administered the medications to patients as she had

recorded, but rather had taken the Dilaudid for her own use. Each fraudulently recorded administration was

billed to each patient’s insurance company. One patient was insured through Jameson Hospital where

UPMC is the third-party benefits manager. The other patient was insured through Medicare. [OTN:

T7202182]

On October 1, 2015, from Negotiated Guilty pleas to Theft by Deception-False Impression and Criminal

Attempt Theft by Deception-False Impression, Angel Luis Carrasco-Rivera of Lancaster, PA was sentenced to

serve three years’ probation and was ordered to pay $1,505.07 in restitution and court costs of $2,444.50. On

May 26, 2015, from a referral received from GEICO Insurance Company, Office of Attorney General special

agents filed a Criminal Complaint charging Rivera with two counts of Insurance Fraud and one count each of

Theft by Deception-False Impression and Criminal Attempt Theft by Deception-False Impression. According

to the complaint, in November 2011, Rivera submitted a claim to GEICO for damages to the left side of his

motorcycle, and a check in the amount of $1,287.86 was issued to a repair shop. According to the complaint,

the shop owner cashed the check and gave Rivera the money as he had reportedly not wanted to repair the

motorcycle at that time. On May 2, 2013, Rivera obtained a new policy through GEICO and, on May 30,

2013, filed another claim stating that the motorcycle had been knocked over and that the motorcycle sus-

tained damage to the left side. GEICO’s adjuster who inspected the motorcycle reportedly recognized both

the motorcycle and damages were the same as the damages he had prepared an estimate for in November

2011. Rivera, once confronted by GEICO’s adjuster with this information, admitted that the damage had

been pre-existing and withdrew the claim. However, according to the complaint, special agents discovered that

on May 17, 2014, Rivera had submitted another claim to Nationwide Insurance regarding damages to the left

side of the motorcycle and that Nationwide paid Rivera $1,515.07 for that claim. [OTN: T6573383]

Know the Risks, Know the Penalties Page 10

“The complaint alleges that

Loutzenhiser had not

administered the

medications to patients as

she had recorded, but rather

had taken the Dilaudid for

her own use.”

The Penalties: The following dispositions of cases previously reported on were obtained via

the web portal of Pennsylvania’s Unified Judicial System.

Harrisburg, PA

Man Pleads

Guilty to

Insurance

Fraud &

Related

Charges;

Sentenced to

Intermediate

Punishment

Program

Page 9

On October 2, 2015, Dana C. Garner of Philadelphia, PA pled Guilty to Criminal Attempt Theft by Decep-

tion-False Impression and was sentenced to serve 12 months' probation and was ordered to pay court costs of

$697.50. On June 24, 2015, Office of Attorney General special agents filed a Criminal Complaint charging

Garner with Insurance Fraud and Attempted Theft by Deception-False Impression. According to the com-

plaint, on September 17, 2015, Garner obtained an auto insurance policy with Progressive Insurance Compa-

ny and on September 21, 2015, reported to Progressive that she had been involved in an accident earlier that

day. According to the complaint, an Indiana Borough Police Department accident report stated that the acci-

dent occurred on September 15, 2015, two days before she had obtained her Progressive policy. [OTN:

T6688776]

On October 2, 2015, a Finleyville, PA man was granted ARD with 12 months' probation and was ordered to

perform 100 hours of community service, pay $250 in restitution and court costs totaling $2,206. The defend-

ant had been charged in May 2015 with two counts of Insurance Fraud by detectives of the Allegheny County

Police Department. According to the Criminal Complaint, the defendant made changes to his Progressive

Insurance auto policy on November 13, 2013. The defendant changed his policy to reflect himself as an ex-

cluded driver and added another individual as the driver of his 2010 Mitsubishi Lancer. On November 18,

2013, the defendant's Lancer was involved in an accident when it struck a 1994 Honda Accord. It was alleged

that the defendant was operating the Lancer at the time of the accident, but had given another individual's

name as the defendant had listed himself as an excluded driver prior to the accident on November 18. Accord-

ing to the complaint, the driver of the Honda had identified the defendant as the driver of the Lancer when

the accident occurred. [OTN: G7102421]

On October 5, 2015, David Lee Stewart of Harrisburg, PA pled Guilty to Insurance Fraud and Criminal At-

tempt Theft by Deception-False Impression and was sentenced to serve five years in an Intermediate Punish-

ment Program and was ordered to perform 100 hours of community service and pay $10,037 in restitution as

well as court costs. On June 25, 2015, Office of Attorney General special agents had filed a Criminal Com-

plaint in Dauphin County charging Stewart with Insurance Fraud, Theft by Deception-False Impression and

Criminal Attempt Theft by Deception-False Impression. According to the complaint, it had been alleged that

Stewart, from September 7, 2011 through December 13, 2012, had misrepresented the facts surrounding mul-

tiple property claims for alleged basement flooding at his rented residence. Stewart allegedly submitted several

fraudulent receipts and made false statements to USAA Insurance Company in an attempt to collect some

$40,000 in insurance funds to which he was not entitled. The complaint reflects that Stewart submitted three

separate claims and had received over $74,000 from USAA. [OTN: T6693234]

On October 5, 2015, from a Non-Negotiated Guilty plea to Manufacture, Delivery or Possession with Intent to

Manufacture or Deliver, Ryan Kerr of Collingdale, PA was sentenced to serve 23 months' confinement fol-

lowed by three years' probation and was ordered to pay court costs totaling $3,590. In July 2015, detectives of

the Delaware County District Attorney’s Criminal Investigation Division had filed a Criminal Complaint

charging Kerr with one count of Insurance Fraud and three counts each of Manufacture, Delivery or Posses-

sion with Intent to Manufacture or Deliver, Possession of Controlled Substance and Use or Possession of Drug

Paraphernalia. According to the complaint, it was alleged that Kerr utilized his Keystone First Medical Insur-

ance to acquire prescriptions of controlled substances to include Suboxone and Clonazepam, and would then

sell the medications for profit. [OTN: L9581854]

On October 7, 2015, a Phillipsburg, PA woman was granted ARD with six months' probation and was ordered

to pay $1,402.75 in court costs. On July 1 and 28, 2015 respectively, detectives of the Lehigh County District

Know the Risks, Know the Penalties

Fraud Stories (Continued)

Page 11

Fraud Stories (Continued)

Attorney’s Insurance Fraud Unit filed two Criminal Complaints charging a 52 year-old woman and a 31 year-

old woman, both of Phillipsburg, NJ, with Insurance Fraud. According to the complaints, it had been alleged

that the defendants, both New Jersey residents, registered their vehicles by using Easton and Whitehall, PA

addresses so as to avoid paying higher insurance premiums. One defendant had insured her vehicle with Pro-

gressive Insurance Company, and the other defendant’s vehicle was insured with Access Insurance Compa-

ny. The second defendant has not yet been sentenced. [OTN: T6717616, T6824580]

On October 8, 2015, John A. Lowry of Connellsville, PA pled Guilty to Workers’ Comp Fraud-Receives Ben-

efits and was sentenced to serve 23 months' confinement and was ordered to pay $8,302.50 in fines,

$4,151.25 in restitution and court costs of $1,944.25. On June 22, 2015, Office of Attorney General special

agents filed a Criminal Complaint charging Lowry with Workers’ Comp Fraud-Receives Benefits and Theft by

Deception-False Impression. The complaint reflects that on February 6, 2014, Lowry sustained a work-related

injury to his wrist while working for Laurel Highlands Restoration Services. On August 14, 2014, Lowry was

re-evaluated by a doctor and ordered to remain off work while undergoing physical therapy. According to the

complaint, Lowry never attended any physical therapy appointments and continued to receive wage loss

checks from Cincinnati Insurance Company. An investigation revealed that on August 20, 2014, Lowry be-

gan employment with PuroClean Restoration Services, and between September 2, 2014 and October 21,

2014 had received and cashed five workers’ compensation benefit checks totaling $4,151.25 to which he was

not entitled. [OTN: T6677823]

On October 14, 2015, from a Negotiated Guilty plea to Insurance Fraud, Chris Michael Carollo of Philadel-

phia, PA was sentenced to serve three years' probation and was ordered to pay $20,070.29 in restitution and

court costs of $749. On April 20, 2015, from a referral received from State Farm Insurance Company, detec-

tives from the Philadelphia District Attorney’s Office Insurance Fraud Unit arrested Carollo and charged him

with Insurance Fraud, Theft by Unlawful Taking and False Reports. According to the Criminal Complaint,

on August 24, 2012, Philadelphia Police Officers from the 3rd District responded to a call placed by Carollo,

in which he stated that his 2012 Jeep Liberty had been stolen sometime between the evening of August 23 rd

and the morning of August 24th. Carollo stated that he had last parked his vehicle in the vicinity of 12th and

Wolf Streets and that the vehicle had been financed with Ally Financial. Carollo then filed a theft report with

State Farm Insurance Company and Reliance Insurance Company, which provides gap coverage for in-

sureds. Insurance Fraud Unit detectives were later contacted by a detective in Newtown Township, Bucks

County who had recovered Carollo’s vehicle. Detectives later determined that the car had not been stolen but

had been sold by Carollo to a co-worker in order to cease payments and receive an insurance settlement.

[OTN: N9598842]

On October 14, 2015, Roman Ildefonso-Candelario of New Oxford, PA pled Guilty to Obstructing Admin-

istration of Law and was sentenced to serve 18 months' probation and ordered to pay a $250 fine and court

costs of $776.50. From a referral received from a Highmark Insurance Special Investigation’s Manager, the

Cumberland County District Attorney’s Criminal Investigation Division filed a Criminal Complaint on De-

cember 18, 2014 charging Candelario with two counts of Insurance Fraud and one count each of Theft by

Deception-Fail to Correct and Identity Theft. According to the complaint, a complaint was made in Septem-

ber 2014 by Osvaldo Martell Diaz, a resident of New York, who believed his identity had been stolen and was

being used by another, subsequently identified as Candelario. According to the complaint, Diaz was a patient

at Lincoln Hospital in New York and attempted to arrange for a medical procedure, and while registering at

the hospital Diaz was reportedly told that he would be unable to utilize his New York State-funded Medical

Assistance as he had additional insurance through Highmark Blue Shield in Pennsylvania. The investigation

Know the Risks, Know the Penalties Page 12

“Detectives later determined

that the car had not been

stolen but had been sold by

Carollo to a co-worker in

order to cease payments and

receive an insurance

settlement.

...Carollo was sentenced to

serve three years’ probation

and was ordered to pay

$20,070.29 in restitution.”

revealed that the name, date of birth and social security number given by Diaz in New York was the same that

Candelario provided and further that Candelario had numerous dates of service from various providers that

resulted in Highmark Blue Cross Blue Shield paying some $23,499.91 in medical bills of Candelario. [OTN:

T6016662]

On October 14, 2015, from a Negotiated Guilty plea to Insurance Fraud and Criminal Attempt Theft by De-

ception-False Impression, Seth Michael Vanderella of Greensburg, PA was sentenced to serve two years' proba-

tion and was ordered to perform 50 hours of community service and pay court costs totaling $1,577.10. On

May 26, 2015, Office of Attorney General special agents had filed a Criminal Complaint charging Vanderella

with two counts of Insurance Fraud and one count of Criminal Attempt Theft by Deception-False Impression.

According to the complaint, on January 1, 2015 at 6:16 PM, Vanderella purchased an auto insurance policy

with Safe Auto Insurance Company to insure his 2007 Toyota. Subsequently, on January 5, 2015, Vanderella

filed a claim with Safe Auto reporting that his vehicle had sustained damages on January 1, 2015 from gun

shots. It had been alleged that the Toyota’s damages were sustained on January 1, 2015, before Vanderella ob-

tained the Safe Auto policy, as Delmont Police reports show that they had responded to a call for gunfire on

January 1, 2015 at 12:17 AM. According to the complaint, Safe Auto did not pay the $3,294.51 for the Toyo-

ta’s damages. [OTN: T6573593]

On October 16, 2015, Robert Cantafio of Norwood, PA was found Guilty of Manufacture, Delivery or Posses-

sion with Intent to Manufacture or Deliver and was sentenced to a maximum six years' confinement followed

by three years' probation and was ordered to pay court costs totaling $1,240. In February 2015, detectives of the

Delaware County District Attorney’s Criminal Investigation Division arrested Cantafio and charged him with

two counts each of Insurance Fraud, Manufacture, Delivery or Possession with Intent to Manufacture of Deliver

and Possession of Controlled Substance, and one count of Criminal Use of Communication Facility. Accord-

ing to the Criminal Complaint, it was alleged that Cantafio had obtained prescription medications to include

the controlled substances Morphine, Xanax and Alprazolam that were paid for through Medicaid and would

then sell the pills on the street for a profit. According to the complaint, Cantafio had sold pills to an undercov-

er detective on several occasions. [OTN: T6230044]

On October 19, 2015, Kristie E. Sallada of Lyons, PA pled Guilty to Insurance Fraud and was sentenced to

serve two years' probation and was ordered to perform 50 hours of community service and pay court costs of

$245. On April 7, 2015, Office of Attorney General special agents had arrested and charged Sallada with two

counts of Insurance Fraud. According to the Criminal Complaint, Sallada’s automobile policy with the Progres-

sive Insurance Company was canceled on November 23, 2012 due to non-payment. At 4:51 PM on March 5,

2013, Sallada allegedly purchased a new Progressive policy which included liability, comprehensive and collision

coverage for her 1996 Chevrolet C1500. According to the complaint, Sallada told the insurance company that

she had not been involved in any accidents prior to purchasing the coverage. On March 8, 2013, Sallada alleg-

edly gave a recorded statement to Progressive, indicating that her Chevrolet collided with another vehicle at

approximately 5:15 PM on March 5, 2013. However, according to the complaint, investigators determined that

the accident actually occurred at 2:45 PM, prior to the time Sallada obtained her Progressive policy. [OTN:

T6396913]

On October 21, 2015, a Weatherly, PA man was granted ARD with 12 months' probation and was ordered to

pay $1,550 in court costs. In March 2015, detectives of the Delaware County District Attorney’s Criminal In-

vestigation Division had filed a Criminal Complaint charging the defendant with Insurance Fraud, Criminal

Attempt Theft by Deception-False Impression and Criminal Use of Communication Facility. According to the

Page 11 Page 13 Know the Risks, Know the Penalties

Fraud Stories (Continued)

Norwood, PA

Man Guilty in

Prescription

Fraud Case;

Sentenced to

Six Years’

Confinement

Followed by

Three Years’

Probation

complaint, on February 16, 2011, a Liberty Mutual Insurance Company insured homeowner filed a home-

owners insurance claim for water damage to his home’s living and dining room ceilings. Liberty Mutual paid

the homeowner $3,840.79 on the claim. The homeowner, according to the complaint, had hired the defend-

ant, owner of Federal Adjustment Services, and reportedly signed an agreement with the defendant that the

defendant would receive 35% of any money gained through the claim. In April 2014, the homeowner again

hired the defendant for an unrelated matter on the exterior of his residence. The defendant, upon entering

the home to speak about the home’s exterior issue, reportedly noticed the damage to the ceiling in the living

and dining room ceilings which the homeowner had not had repaired from the Liberty Mutual claim. The

defendant, on April 26, 2014 on the homeowner’s behalf, reportedly filed a claim for the same damages to the

home’s living and dining room ceilings to USAA Insurance Company and subsequently faxed an estimate of

$9,875 for the same damages. Further investigation revealed that the photos taken by both Liberty Mutual and

USAA in support of each claim showed identical damage. USAA did not pay the claim. [OTN: T6327156]

On October 27, 2015, a Hanover, PA man was granted ARD with 12 months' probation and was ordered to

perform 35 hours of community service and pay court costs of $1,837.50. On June 29, 2015, detectives of the

York County District Attorney’s Office had filed a Criminal Complaint charging the defendant with Insur-

ance Fraud and Attempted Theft by Deception-False Impression. According to the complaint, on February 5,

2015 at approximately 9:30 AM, the defendant's vehicle was involved in a non-reportable motor vehicle crash

while being operated by his live-in girlfriend. The defendant reportedly arrived to the scene and took a photo-

graph of the other involved vehicle’s damage with his cell phone. Metadata from the cell phone photo showed

the photo was taken on February 5, 2015 at 9:36 AM. Reportedly, records reflect that at approximately 9:49

AM, the defendant contacted The General Insurance Company to reinstate his lapsed policy, and on Febru-

ary 6, 2015, contacted The General Insurance Company to file a claim. In filing the claim, the defendant

reportedly stated that the accident had occurred after he had reinstated his lapsed policy; however, he later

reportedly admitted that he lied to the insurance company because he knew his policy had lapsed. [OTN:

T6707256]

On October 27, 2015, a Dallastown, PA woman was granted ARD with 12 months' probation and was or-

dered to perform 35 hours of community service and pay $1,831.50. On July 2, 2015, insurance fraud detec-

tives of the York County District Attorney’s Office filed a Criminal Complaint charging the defendant with

two counts of Insurance Fraud and one count of Criminal Attempt Theft by Deception-False Impression.

According to the complaint, on May 22, 2015 9:28 AM, York County 911 Center received a report of a motor

vehicle crash involving a vehicle registered and assigned to the defendant's son. The defendant contacted Safe

Auto Insurance Company on May 22, 2015 at approximately 10:40 AM to purchase a policy for her vehicle,

reportedly stating that her vehicle had not sustained any prior damage and that no one over the age of 15

years of age resided with her. The defendant, at approximately 12:18 PM, contacted Safe Auto again and re-

ported a crash had occurred at approximately 11:10 AM, after she had obtained the new Safe Auto policy. She

reportedly stated that she had been driving her vehicle when she rear-ended her son’s vehicle, stated that she

believed her vehicle was totaled and then inquired about how to have her son’s vehicle repaired and obtain a

rental vehicle until his vehicle was repaired. Further investigation revealed that at the time the accident oc-

curred, the defendant's vehicle was uninsured and she had reportedly admitted later that she purchased the

Safe Auto policy after the accident had occurred. According to the complaint, Progressive Insurance Company

paid to have the defendant's son’s vehicle repaired, and the complaint states that had the defendant's Safe

Auto policy been in force at the time of the crash, Safe Auto would owe over $5,000 to Progressive in reim-

bursement costs. [OTN: T6719985]

Page 14 Know the Risks, Know the Penalties

Fraud Stories (Continued)

Defendants

Granted ARD in

York County

On October 27, 2015, Angel Harp Achatz of Vandergrift, PA pled Guilty to Insurance Fraud and was sen-

tenced to serve 18 months' probation and was ordered to pay $400 in fines, $250 in restitution and court

costs totaling $1,112.50. On March 4, 2015, Office of Attorney General special agents had filed a Criminal

Complaint charging Achatz with two counts of Insurance Fraud and one count of Theft by Deception-False

Impression. According to the complaint, it was alleged that Achatz, in an effort to obtain an auto insurance

policy of Safe Auto Insurance Company, had not disclosed that she had just been involved in a two-vehicle

accident in which she was the at-fault driver. The driver of the other vehicle subsequently filed a claim against

Achatz’s newly obtained Safe Auto policy. According to the complaint, when Safe Auto contacted Achatz

about the claim, she stated that the accident had occurred at 2:00 PM when in fact, the accident had occurred

at 11:30 AM, prior to her new policy’s inception. State Farm had paid $883.48 to include Anchatz’s $250

deductible to settle the claim. [OTN: T6281634]

On October 29, 2015, Tracy Lynn Ayers of McKeesport, PA pled Guilty to Criminal Attempt Theft by Decep-

tion-False Impression and Forgery and was sentenced to serve 18 months' probation and was ordered to pay

$2,043.75 in court costs. On March 2, 2015, Office of Attorney General special agents had filed a Criminal

Complaint charging Ayers with Insurance Fraud, Theft by Deception, Forgery and Identity Theft. According

to the complaint, on January 24, 2013, Ayers was involved in a single-vehicle crash and was transported by

emergency medical services to a local hospital for treatment of a fractured shoulder. Ayers, in support of a

claim, provided a Wage and Salary Verification form indicating that she was employed as a home health aide

from April 2009 until March 2013. Ayers claimed on the form that she was providing medical care aide to her

boyfriend’s father at the time and was being paid cash for her services. Ayers had reported on the form that

she was unable to work from January 2013 through March 2013 as a result of injuries she sustained in the

accident, claiming $1,134 in lost wages to State Farm Insurance Company. Further investigation revealed

that Ayers was not and never had worked for her boyfriend’s father as a health care aide and was never paid

by him for any services. [OTN: G7044936]

On October 30, 2015, a Pittsburgh, PA woman was granted ARD with 12 months' probation and was ordered

to perform 300 hours of community service, pay $323.33 in restitution and court costs of $1,947.50. On May

8, 2015, the Allegheny County District Attorney's Office received a case for prosecution regarding the defend-

ant who was charged with multiple counts of Insurance Fraud, Forgery, Prohibited Acts and Identity Theft.

According to the Criminal Complaint, the defendant, while employed as a medical assistant at UPMC Falk

Clinic, had allegedly forged unauthorized prescriptions in the names of her and her stepfather under the

name of a physician at the Clinic, and allegedly obtained the fraudulent scripts by using her UPMC Health

Plan Insurance. [OTN: G7051435]

Page 15 Know the Risks, Know the Penalties

Fraud Stories (Continued)

Bogus Claim of

Lost Wages

Results in

Probation for

McKeesport, PA

Woman

Page 16 National & State Anti-Fraud Events Offer New Knowledge & New Contacts

*April 7—8, 2016 — PA 2015 Insurance Fraud Conference — Hershey Lodge & Convention

Center, Hershey, PA

National & State Anti-Fraud Events Offer New Knowledge & New Contacts

Who to Call

P A I N S U R A N C E F R A U D

P R E V E N T I O N

A U T H O R I T Y

6 Kacey Court, Ste. 101

Mechanicsburg, PA 17055

Page 17

Insurance Fraud

Allegheny County DA’s Office, (412) 461-2328

Allegheny County PD, (412) 473-1254

Attorney General’s Office, (717) 787-0272

Bucks County DA’s Office, (215)348-6344

Cumberland County DA’s Office, (717) 240-7764

Delaware County DA’s Office, (610) 891-4700

Erie Bureau of Police, (814) 870-1258

Lehigh County DA’s Office, (610) 264-8758

Montgomery County DA’s Office, (610) 278-3472

NE Insurance Fraud Task Force, (570) 963-5177

Philadelphia DA’s Office, (215) 686-8723

York County DA’s Office, (717) 771-9600 x 329

Arson

Dauphin County DA’s Office, (717) 255-2770

PA State Police-Fire Marshals, (717) 346-4597

Anti-Fraud Compliance

PA Insurance Department, (717) 705-4199

Phone: 717-691-1828

Fax: 717-697-1013

www.helpstopfraud.org

IFPA Staff

Thomas Donahue, Executive Director, tdonahue@helpstopfraud.org

Joan Dockery,

Associate Executive Director, jdockery@helpstopfraud.org

Christine Cassel, Grants Administrator, ccassel@helpstopfraud.org