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ICU Investigations
125 North Route 73
West Berlin, NJ 08091

Phone: 856-988-6777
Fax: 856-988-0727
Toll Free:
800-524-9755

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ICU Does Not Overlook the Opportunity to Utilize OPRA Requests

OPRA requests are one of the best tools the public has to obtain government information on a state, county, or municipal level. This New Jersey law is often overlooked as a means to collect public information, but the New Jersey Open Public Records Act mandates that the public agency produces the record requested within seven business days of receiving the request.


We can request records from specific departments (then an agency within that department) such as:

  • Agriculture
  • Banking and insurance
  • Children and families
  • Civil service commission
  • Commissions and agencies
  • Community affairs
  • Corrections
  • Education
  • Environmental protection
  • Office of Governor
  • Health
  • Human Services
  • Labor
  • Law and public safety
  • Military and veterans affairs
  • State
  • Transportation
  • Treasury
  • And many more!


It is important to remember that some records are exempt from disclosure. Exempt records are listed below:


  • Criminal Investigation Records
  • Records relating to an ongoing investigation
  • Personnel/pension records (with some exceptions)
  • Inter- or intra-agency advisory
  • Consultative or deliberative material (drafts of documents)
  • Records protected by court order
  • Records protected by attorney-client privilege
  • Job applicant records
  • Fingerprint cards
  • Illegitimacy records
  • Records that would substantially impair the state’s ability to defend against sabotage or terrorism
  • Legislative records
  • Medical examiner records
  • Victims’ records
  • Trade secrets and proprietary commercial or financial information
  • Administrative or technical information regarding computer hardware, software and networks which, if disclosed would jeopardize computer security
  • Emergency or security information or procedures for buildings or facilities which, if disclosed, would jeopardize security of the building or facility or persons therein
  • Security measures and surveillance techniques which, if disclosed, would create a risk to the safety or persons, property, electronic data or software
  • Information which, if disclosed, would give an advantage to competitors or bidders.
  • Information generated by or on behalf of public employers or public employees in connection with:
    • Any sexual harassment complain filed with a public employer
    • Any grievance filed by or against an individual
    • Collective negotiations including documents and statement of strategy o0r negotiating position
  • Information which is a communication between a public agency and its insurance carrier, administrative service organization or risk management office
  • Certificate of honorable discharge issued by the US government filed with a public agency
  • Personal identifying information (social security numbers, credit card numbers, unlisted telephone numbers, drivers’ license numbers)
  • Certain records of higher education institutions (academic research records, test questions/scoring keys/etc)
  • Biotechnology trade secrets
  • Limitations to convicts – personal information pertaining to the person’s victim or the victim’s family, including but not limited to a victim’s home address, home telephone number, work or school address, work telephone number, social security account number, medical history or any other identifying information
  • Public defender records that relate to the handling of any case
  • Privacy Interest – “a public agency has a responsibility and an obligation to safeguard from public access a citizen’s personal information with which it has been entrusted when disclosure thereof would violate the citizen’s reasonable expectation of privacy.”

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This is What We Do…Every Single Day

We found an article that pretty much sums up what we do on a daily basis to build an internet profile report for our clients. Not only does this illustrate perfectly how we build the bigger picture for you, but it also demonstrates the rewards (and potential harm) that social media has in our daily lives.


Joe Stephenson of PropertyCasualty360 tells the story of his walk around CalTech campus located in Pasadena, California where he stumbled upon a college ID on the ground. With limited time to try to locate the ID’s owner, and realizing that the ID actually belonged to a student at another local college, he figured he could conduct a little search to try and develop an address so he could politely drop the lost ID in the mail and it would find its way home in the student’s mailbox.


But what Joe Stephenson found was not what he was expecting. This girl’s entire life was plastered all over the internet.


“Mind you, this is a very bright and intelligent young woman, but like most her age she lacks a clear understanding of how the internet can be used – and this is from someone who has been essentially raised during this technological age. Good for those of us fighting evil but bad, very bad, when evil is searching for a target,” proclaims Stephenson.


By conducting one quick Google search on his PHONE (no utilization of databases or paid sites), using the only information that he knew about her (her name, the college she attends, and her picture), Joe uncovered the following information about the unsuspecting student:


Her studies: projected graduation year, her approximate age, what she studied, who her professor was, where she would likely be on campus, and more photos. He knew her aspirations, future projects, and read a technical paper she wrote. Ok…some basic research, but a bunch of new avenues to explore.


After that quick Google search which uncovered some unique photos of the student, Stephenson took to the Images tab in Google and found:


She likes yoga (he was able to see where and what time), she likes beer, prefers dogs over cats, prefers a specific airline, she is from a city in Northern California, she was the editor of her high school yearbook in said city, she lived locally, and she owned a Prius and/or a Honda (both license plates were pictured in a photo).
She had just returned from a trip to Australia this past July (specifically in Sydney, Australia on July 5th).
She also included a picture of her drivers license in one of the photos she posted!


Stephenson said, “California is one of the strictest states regarding the disclosure of DMV data and PII (Personally Identifiable Information) and this young woman is giving it away to everyone! I didn’t have a specific physical address, but I did have her name, date of birth, driver’s license number, school information, vehicle info, hometown and high school. Finding her mother’s maiden name would only have been a few more clicks away and then I’m making my own Visa cards! Skip going to her home and breaking in and risk getting caught – this guy just became an identity thief!”


We apply these techniques to our claims investigations every day. And as scary as it may be, there are people out there who don’t realize how dangerous it may be to post their personal information online and on social media…but they do it anyway (good for us). If the information is out there, we will find it!


Stephenson could not have wrapped this article up with a better statement: “Take what you want from this research example, but do not ignore the importance of using the internet or making it a mandatory resource during investigations.”

 

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New Jersey Woman Pleads Guilty to Submitting $500K in Fraudulent Med Claims

According to Kathleen Hopkins of the Asbury Park Press, 40-year-old Middletown resident, Donna Dzienisewski, plead guilty to healthcare claims fraud last month, admitting that she submitted over $500,000 in fraudulent insurance claims for medical procedures she never received.


Acting Attorney General John J. Hoffman and acting Insurance Fraud Prosecutor Ronald Chillemi stated in a news release that Dzienisewski admitted to Superior Court Judge Anthony J. Mellaci Jr. that between March 18, 2011 and March 12, 2013, 107 claims were submitted to Horizon Blue Cross Blue Shield of New Jersey for approximately $502,740 in healthcare expenses, including 107 doctor visits.


However, an investigation launched after Dzienisewski was paid $141,126 by HBCBS of NJ. As the rest of her claims were pending, investigators determined that she had only incurred six doctor visits between March 18, 2011 and March 12, 2013. The expenses for those visits should have totaled $2,640, according to the news release. But for those particular visits, Dzienisewski claimed the expenses totaled $8,640.


The sentencing hearing is scheduled for February 6, 2015. Dzienisewski’s plea deal saved her from spending up to 10 years in prison. As part of the plea bargain, the state will recommend a five-year sentence, repayment of $10,000 in restitution, and a civil consent judgment totaling $50,000.


Since most of the money Dzienisewski collected from the insurer has been spent, the civil consent judgment will place a lien on her assets and will ensure that if she ever stumbles upon some money, it can be recovered.

 

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Brad Culpepper, Former NFL Player, Competed on “Survivor”, Sparked Workers Comp Fraud Suit

Adam Walser of ABC7 News Denver reported last month that Brad Culpepper, former defensive tackle in the NFL, has been accused of workers compensation fraud after appearing on the popular reality show, “Survivor” with his wife.


Culpepper’s career shifted from football player, to personal injury attorney, to reality TV competitor in 2013.


What sparked the accusations? According to ABC7 News Denver, “In 2010, Culpepper filed a workers comp claim in California, where there was no statute of limitations and any player who had ever played a game in the state was eligible to file.” After Culpepper’s claim was filed, California legislators have since changed the law to permit players of teams based in California to file claims.


The NFL Players Association advised former players to file claims, and the NFL and their insurers have paid out hundreds of millions of dollars.


According to Christopher Fusco, an attorney who happens to represent insurance companies while writing a blog featuring legal issues in sports, says “I think that he’s a person they’d like to make an example out of.”


Insurers for the NFL have filed a lawsuit, noting that Culpepper was declared 89% disabled in 2010 and settled his claim for $175,000, a mere 2 years before earning a black belt in mixed martial arts in 2012 and 3 years before appearing on “Survivor” with his wife, Monica in 2013. The suit also highlights that Culpepper claimed he lost quality of life. Culpepper told doctors that “pain interfered with his daily activities, concentration and thinking a lot, or most of the time.”


“He said he can’t do recreational activities,” states Fusco. “He’s limited in what he can do, he has pains every day of the year. And now he’s living on a desert island and he’s swimming and killing fish with his hands and eating bamboo, so that’s going to upset the insurer.”


Culpepper’s attorney, Scott Shutzman, is planning on asking the court to throw out the case, as his client was legitimately injured and he should have been awarded compensation. “There were injuries that were confirmed by no less than 14 or 15 MRI’s, various x-rays, legions of doctors,” states Shutzman. His attorney feels Culpepper had answered all questions honestly.


Shutzman also argues that, “there’s nothing that I’ve seen that says an 89 percent disability rating says you can’t be on a TV show, or do an MMA workout.”


Also worth mentioning, according to ABC7 News Denver, is that “Culpepper was the lead plaintiff in the recent NFL brain jury lawsuit, which was tentatively settled for $765 million.”


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2012′s Top 10 Workers Comp Fraud Cases Cost America a Whopping $97 Million

Employees, employers, and healthcare providers alike commit workers compensation fraud. Below, a Texas Workers Compensation Blog put together a comprised list of the top 10 workers compensation fraud cases in the year 2012, which cost America $97,446,500 (making it much easier to understand how insurance fraud costs us BILLIONS each year).


1. “Operation Dirty Money” (Florida)

Owner of the Oto Group, Inc. and 10 Shell companies, Hugo Rodriguez, along with seven accomplices, shafted over $70 million in undeclared payroll using several different money services. Rodriguez avoided paying workers’ compensation premiums and coverage using his 10 Shell companies, while scamming legitimate businesses and putting the lives of countless employees at risk.


2. 41,247 Private Employers Failed to Report Payroll Data (Ohio)

41,247 private businesses/companies in Ohio violated state law by failing to report and pay workers’ compensation premiums, which totaled approximately $5.6 million. And the remaining businesses that actually paid their premiums? Their costs were raised.


3. Employee Leasing Companies…too Good to be True? (Texas)

Texas based company, Jackson Brothers Hot Oil Service, decided to hire a staffing agency back in 1999 to funnel in some temporary workers. The staffing agency was required to purchase workers’ compensation for the workers they provided and took out a $4,100 policy. When one of the agency’s workers was severely injured from an explosion, the agency declined to pay the medical bills that ensued. The injured employee and the Jackson Brothers sued the staffing agency for fraud and won $4,466,500 in 2012.


4. Business Owner Under-Reports Payroll by $3.5 Million (California)

Construction business owner, George Osumii, lied to the State Compensation Insurance Fund by under-reporting his employee payroll by $3.5 million from the years 2001 to 2006. Osumii avoided paying $814,000 in premiums.


5. Roofing Company and Owners Sentenced for Labor Violations (Massachusetts)

Newton Contracting Company, Inc and its owners labeled half of their employees as subcontractors (even though they weren’t) and concealed over $3.4 million worth of payroll during annual audits. The Massachusetts Insurance Fraud Bureau discovered the fraud.


6. Like Father, Like Son (California)

Business owner, Steven Morales, hid his payroll to avoid paying workers compensation premiums that totaled approximately $3.1 million. Morales was convicted and sentenced to seven years in prison. Morales’ son Brian was also convicted and sentenced to four years in prison.


7. Construction Company President Accused of Payroll Fraud (Florida)

The president of Navarre Industries, Inc., Randall Seltzer, was charged with workers’ compensation fraud (among several other felony counts) for under-reporting payroll to his insurer according to an investigation conducted by Florida’s Department of Financial Services Division of Insurance Fraud. Seltzer is facing up to 30 years in prison and restitution payments totaling over $2.9 million.


8. Fake Business Owner Fabricated Insurance Certificates (Florida)

Yucet Batista focused his entrepreneurial efforts in creating a bogus company, obtained workers’ compensation benefits, and “rented” the benefits to subcontractors for a fee. Batista helped the uninsured subcontractors avoid paying $2.1 million in premiums by providing more than 250 fraudulent certificates of insurance.


9. 12 Audits Uncovered $1.2 Million in Workers’ Compensation Violations (Massachusetts)

The Boston Marriot renovation project was enormous, and so were the violations of unreported wages.

Between seven companies, there were $584,249.00 in misclassified 1099 wages and $584,287 in unreported W-2 earnings, totaling $1,171,536.00. Six of these companies registered workers as contractors instead of employees.


10. Owners of Historic Inn Face Fraud Charges (California)

Sanjiv and Neelam Kakkar, owners of historic Brookdale Inn and Spa, are facing charges for falsifying wage information to their insurer to lower insurance premiums. Over a several year period, the Kakkar’s paid approximately $800,000 less in premiums than they should have.

 

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New Jersey Man Indicted in Carjacking Insurance Plot

According to the acting Attorney General, John Hoffman, 42-year-old Maurice Douglas of East Orange, NJ has been charged with insurance fraud, attempted theft by deception and false reports to law enforcement last month.


NBC Philadelphia reported that Douglas claimed he was carjacked in March of 2014 by two men, one with an assault rifle, who “stole his 2007 Mercedes S-550 as he exited the vehicle at his house.” Douglas also noted that one of the alleged carjackers robbed him of his cell phone, and one other vehicle was used in the escape.


Douglas alerted the East Orange police that same day, along with his insurer in an attempt to collect approximately $38,500.


Police found Douglas’ 2007 Mercedes in an abandoned lot the next day. According to NBC Philadelphia, the car had suffered significant damage with “its headlights and taillights stripped with evident damage to its body and windshield.”


Douglas revealed the alleged carjackers’ escape route in which police retrieved time- and date-stamped surveillance video. The ensuing investigation showed no video evidence of Douglas’ Mercedes or the other getaway car taking the alleged escape route.


If Douglas is convicted on all counts, he could be facing 17 years in prison.


 

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