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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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Insurance Fraud Hall of Shame – Class of 2014

Every December, in an effort to raise public awareness, the Coalition Against Insurance Fraud chooses a new class of insurance fraud inductees, as posted by PropertyCasualty360, and it’s our favorite time of the year! We enjoy seeing these investigations lead to convictions, as many of the individuals listed below are true monsters and their crimes are NOT victimless.


According to Dennis Jay of PropertyCasualty360, “they represent the most brazen, vicious or klutziest insurance cons of the last year. Small wonder, they inflicted costly fakes and pains on consumers and insurers throughout the nation.”


1. Dr. Spyros Panos of Poughkeepsie, NY: Malpractice Fraud


Dr. Spyros Panos, an orthopedic surgeon, raked in approximately $35 million through the submission of fraudulent claims for an outrageous amount of botched/faked surgeries.


Orthopedic surgeons typically perform 20 surgeries a month. Well, Panos was rushing through up to 20 surgeries A DAY.


Dennis Jay writes, “Panos bounced from operating room to operating room in quick sequence. He performed substandard surgeries, or just sliced open patients and stitched them up without making repairs. Panos also billed routine arthroscopic procedures as expensive open surgeries.”


Victims have had useless surgeries, can’t walk, can’t recover, can’t work, and the list goes on.


Panos was convicted and will spend 4½ years in federal prison. In addition, Panos faces approximately 260 malpractice suits.


2. Angela Garcia of Cleveland, OH: Insurance Fraud


Angela Garcia set fire to her home using flammable liquid with her two infants, Nyeemah (whom Garcia tied up with a window blind cord to prevent escape) and Nija, inside. Both girls died from smoke inhalation before firefighters were able to reach them.


According to Jay, “She showed no grief or other emotions,” and “freely socialized afterwards.” She then proceeded to make claims for items she didn’t own, removed items from her home before she started the fire, all to collect $64,000 in insurance payments.


Prosecutors said Garcia’s alleged escape, crashing through a second-floor window and sliding down the roof, was impossible. She was not dirty, had no cuts, and did not receive treatment for smoke inhalation.


Prosecutors also proved that Garcia wanted nothing more to do with her children. She was convicted of insurance fraud and the murders of her two children. She will spend the rest of her life in prison.


3. Andy Lee House of Galveston, TX: Insurance Fraud


Andy Lee House decided to cash in on his $2.2 million car, a rare Bugatti Veyron, by crashing it into a swampy lagoon. House submitted the claim to his insurer, alleging that “a low-flying pelican forced him to swerve off the road into the muck.”


Luckily, a car enthusiast was at the right place at the right time, and in an attempt to record a video of the Bugatti, he caught House on video driving off the road and into the lagoon (no pelicans, skid marks, or other evidence for the cause of the crash in sight).


After crashing into the lagoon, House left the engine running for approximately 15 minutes, which allowed the salt water to engulf the engine and ruin the car. His excuse for not turning off the engine? Fighting off mosquitoes.


House pleaded guilty and faces up to 20 years in federal prison when sentenced.


4. Joseph Haddad of Bridgeport, CT: Medical Insurance Fraud


Joseph Haddad, a personal-injury attorney, gathered a network of (crooked) doctors, chiropractors, diagnostic clinics and recruiters.


“Recruiters” would visit police stations daily to buy accident/crash reports, which included victim’s identities. They were then tasked to hassle the crash victims to hire Haddad as their personal-injury lawyer.


Providers (doctors/chiropractors/clinics) then “diagnosed the victims, often without exams, then billed insurers for months of phantom or useless treatment.”


A sting operation in which federal agents posted as crash victims finally exposed Haddad. According to PropertyCasualty360, “One agent was billed for 11 chiro exams even though he only received four treatments. One of Haddad’s doctors, meanwhile, was operating with a suspended license.”


Haddad was sentenced to serve 51 months in federal prison with restitution payments totaling $1.8 million.


5. Christopher Inserra of New York, NY: Workers’ Comp Fraud


Former NYPD officer, Christopher Inserra, claimed he hurt his right arm while transporting an injured employee of the Port Authority to treatment. Even though medical exams showed there were no serious injuries, Inserra insisted he couldn’t bend his arm and the pain was extreme in his elbow and bicep. He collected over $31,000 in workers’ compensation benefits, until…


NOTE: DO NOT FIST PUMP WITH ARM INJURIES.


Turns out, Inserra was a member of a punk rock band, Cousin Sleaze, who went on a concert tour with stops in Athens, GA, Cocoa Beach, FL, and other locations. Photos and videos from the tour showed Inserra fist pumping, thrashing around, “repeatedly moving his arms in a punching motion” and “violently flailing his arm in an up-and-down motion” on the stage.


Inserra was sentenced to three years of probation.


6. Sara Ylen Port of Huron, MI: Healthcare Fraud


Sara Ylen Port claimed to have contracted cervical cancer, reaching stage four, after she had been raped in a store parking lot. She was now on her death bed.


Her insurance company paid over $120,000 in hospice care, the community raised thousands and the local church raised $10,000 to help with bills. She received recognition in her local newspaper about her “seemingly valiant fight.”


Tragic? No. Ylen made it all up.


Her actions (and actual testimony) sent an innocent man, James Grissom, to jail for almost 10 years as her falsely charged rapist.


According to tests, she did not have cancer. Her life was not in grave danger. She was not on her death bed. The hospice facility kicked her out. An investigation of her home computer found that she researched cancer. Doctors that Ylen named denied involvement and stated they never diagnosed her.


Ylen pleaded no contest and was sentenced to 1 year in jail.


7. Dr. Farid Fata of Detroit, MI: Medicare Fraud


This “doctor” administered “painful and debilitating chemo therapy” treatment to seniors who DID NOT have cancer. According to PropertyCasualty360, “Cancer specialist Fata made $225 million in false Medicare claims. About half went for needless chemo and other cancer treatments. He deliberately misdiagnosed patients who were in remission or had no chance of surviving.”


Medicare was out over $91 million. As if that wasn’t enough, Fata billed private insurers as well.


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


Aside from administering chemo to seniors without cancer, Fata also handed out fraudulent diagnoses of anemia and fatigue so he could provide patients “dangerous levels of billable drugs.”


Fata faces up to 175 years in federal prison. He has not yet been sentenced.


8. Suzanne Basso of Houston, TX: Life Insurance Fraud


Suzanne Basso “befriended” Buddy Musso, a grocery bagger in Manhattan with the IQ of an 8-year-old. Buddy lived in an assisted living home and loved country music. He even dreamed of being one some day.


Basso saw a sick payday when she lured Buddy to Houston by promising to marry him. All she wanted was $150,000 in life insurance benefits (and another $60,000 policy with a violent-death clause) that she and her associates took out on Buddy. They tortured and killed Buddy, then left his body in a ditch covered in bleach.


Basso claimed several fake ailments and disabilities to avoid standing trial, but she was ultimately convicted and executed by lethal injection in February 2014.


9. Pamela Phillips of Aspen, CO: Life Insurance Fraud


Pamela Phillips and Gary Triano, according to PropertyCasualty360, “lived large in the posh foothills of Tucson, Ariz. Gary was a wheeler-dealer, creating businesses, running Indian bingo casinos and playing a lot of golf. They were rich and rubbed shoulders with well-known figures such as the Trumps.”


We’ve all heard the phrase, “More money, more problems.” However, this deemed irrelevant for Triano. Unfortunately, when his businesses collapsed and he lost his fortune, he had more problems than he would have imagined.


Phillips paid her ex-boyfriend, Ronald Young, $400,000 to kill her broke husband (with a car-bomb as he left the country club where he regularly golfed).


Unbeknownst to Phillips, Young recorded their conversations. And financial records were the nail in the coffin.


Phillips was sentenced to life in prison without parole.

 

Source

NJ Man Indicted in Disability Insurance Scam, Indicted Again Week Later with Girlfriend for Additional Insurance Scam

According to an article by the New Jersey Office of the Attorney General, Vinny Curbelo, 31, of Perth Amboy, NJ, was indicted in mid-November of 2014 for a half-million dollar disability insurance scam. One week later, Curbelo and his girlfriend, Nicole Stankovitz, 31, of Perth Amboy, were charged in an additional, complex insurance scam involving the defrauding of an auto insurance company. Talk about the professional claimant!


Acting Attorney General John J. Hoffman and the Office of the Insurance Fraud Prosecutor identified that on November 13, 2014, Curbelo was charged for claiming injuries he had sustained in a fraudulent accident while on site at his employer, DCH Honda in Old Bridge, NJ. Curbelo laid down beside a patch of ice and called for help, claiming he had slipped and injured his back. The investigation identified that insurance covered over $500,000 worth of medical treatment for his back from injuries he had sustained prior to the “accident” ($140,213 was paid by the car dealership’s insurer, Gallagher Bassett).


As if that wasn’t enough, “the defendant accepted approximately $55,803 in temporary disability payments for two years following the faked accident, though it is alleged he was working under the table at a Keyport auto body shop. Also included in the indictment are charges that the man stole approximately $16,700 from the bank accounts of that auto body shop during his term of employment,” according to the Office of the Attorney General.


A week after receiving the indictment for his involvement in the above mentioned insurance scam, Curbelo and his girlfriend, Nicole Stankovitz, were charged for stealing approximately $23,000 from a credit union and defrauding GEICO of more than $32,000 by forging documents related to a stolen SUV.


The indictment noted that Curbelo purchased a stolen 2012 Jeep Grand Cherokee off the black market in August of 2012 with money he and Stankovitz had received from a $23,000 loan provided by Central Jersey Federal Credit Union. However, before the credit union could release funds, they needed the check to be cut to the titleholder of the vehicle. Curbelo and Stankovitz provided a fraudulent Indiana title (including a fake VIN) and listed a friend’s name as the seller.


Curbelo then paid $200 to a friend (same name as the seller on the title) to deposit the $23,000 check and then withdraw the funds in cash and hand the money back to Curbelo. According to the acting Attorney General, the couple then “submitted a falsified Application for Certificate of Ownership to the New Jersey Motor Vehicle Commission (NJMVC) in order to obtain a New Jersey title to this vehicle, which they eventually did receive.”


To complete their complex scheme, the couple added the vehicle, with fraudulent VIN, to their GEICO policy. Approximately two months later on October 22, 2012, “the defendants reported to the police that the vehicle was stolen from them and filed a claim for a theft loss with GEICO. After several months of communications between GEICO and the couple, GEICO settled the ‘theft’ claim for the market value of the vehicle: $32,079.48. From that settlement, a payment was made to CJFCU for $23,897.61 to pay off the loan balance, and Stankovitz pocketed the rest, approximately $8,000. The car itself was recovered in Perth Amboy severely damaged from flooding caused by Superstorm Sandy.”


Acting Attorney General, John J. Hoffman, stated that, “This was a carefully calculated scam that involved many layers of deceit and fraud.”


Judging by the complexity and execution of these two insurance crimes, we made the determination that the accused are clearly professional claimants. Hoffman thought the same: “Given these two indictments, which are based on cases totally separate from each other, it appears Curbelo is a recidivist practitioner of insurance fraud.”


Both have been charged with second-degree insurance fraud, two counts of third-degree theft by deception, third-degree money laundering, third-degree receiving stolen property, third-degree motor vehicle title offenses and third-degree removal or alteration of motor vehicle identification number or mark.

 

Source

Professional Claimants: One of the Biggest Challenges in Conducting an Investigation

One of the biggest challenges we face as investigators in today’s atmosphere, whether conducting surveillance or internal assignments, is the educated and professional claimant!


Aside from our investigative proprietary databases that we legally have access to, you can literally find anything on the internet. We are in a state of constant improvement here at ICU, and our research efforts cover technology, investigative methods, and smart phone apps to aid in investigations, just to name a few.


However, the smarter we get, the smarter the educated claimant becomes. We are not the only people with access to information. A claimant with the means to conduct their own research will most definitely find loopholes and ways to beat the system.


And let’s not forget that some of our claimants are represented and seek information from their counsel!


The best way to keep these claims at bay is to take a proactive approach. We have to stay one step ahead of the claimant at all times, and we take pride in helping you stay ahead of the game.

Vehicle Rate Evaders Beware: Several States are Cracking Down

Howard Goldblatt, director of government affairs for the Coalition Against Insurance Fraud and contributor to their Insurance FraudBlog, posted that several states are cracking down on drivers who falsely register their vehicles in states with lower car insurance premiums.


There will always be a select group of individuals that cheat the system, and the auto-insurance system is no exception. These rate evaders typically don’t drive or live in the states that their vehicles are registered in. And even though not all states and/or jurisdictions recognize rate evading as insurance fraud, the following states/jurisdictions have decided that enforcement is necessary to combat insurance crimes and keep premiums lower for drivers:


Philadelphia/Pennsylvania: According to Goldblatt, “Years ago the then-Philadelphia DA offered amnesty for dishonest drivers to step forward and properly register their vehicles in Philadelphia instead of their falsely claimed addresses in the Philly suburbs or southern New Jersey. A number of folks set their registration record straight – including an employee in the DA’s office.”


North Carolina: More recently, the state identified that out-of-state drivers were registering their vehicles in-state. To crack down on rate evaders, North Carolina changed their policies when registering and insuring vehicles to require drivers to show proof of residence.


New Jersey: Just weeks ago, a bill was passed by the New Jersey Assembly to crack down on drivers lying about where they store or garage their vehicles. If the bill becomes law, more authority would be granted to the state to target these individuals.


New York: Drivers in New York are raising insurance risks and premiums for the state that they are falsely registering their vehicles in, without lowering insurance risks in their own state. How?


According to Goldblatt, “New York has seen insurance investigators, consumer and community groups identify numerous suspicious vehicles parked in residential neighborhoods in Staten Island and Brooklyn. The vehicles oddly had license plates from Virginia, North Carolina, Pennsylvania and Iowa. Visiting friends or relatives don’t own these vehicles. They’re driven by New Yorkers who are cheating the insurance system.”


A bill is in the works in Albany, New York to make false vehicle registering a crime in the state.




Source

Why the ICU Staff Considers LinkedIn a Best Kept Secret

If a claimant has a LinkedIn profile, it’s obviously a fairly easy avenue to develop employment information. LinkedIn’s social platform is meant to connect professionals to one another, whether by industry, geographical area, company, among other criteria. LinkedIn also allows job postings, and attracts many professionals who are looking for work. And for that reason, many users choose to leave their profiles public in hopes of attracting more traffic by potential employers and creating connections (side note: you don’t have to be logged in to LinkedIn to see a public profile). But employment is not the only piece of information to be discovered through this social platform. Take a look at the example below:

 

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Without even being logged in, we just found out where he works, where he interned, a general area where he may live, most of his previous jobs, where he went to college, the type of degree, and that his interests include staying active (possibly working out) with soccer, sports, etc.


Now, we are able to take all of this information, use it to develop the rest of his social media accounts, and run with it. It is people like this individual that make our jobs a tiny bit easier; the people who are willing to share their entire lives with the rest of the world.

Conducting Surveillance in the Intelligence Age

As we all know, surveillance is not what it used to be. Gone are the days that we receive an assignment and start blind.


With all of the resources available to us at our fingertips or with the click of a button, we enhance our ability to locate, investigate and profile claimants to ensure a cost-effective investigation.


The pre-surveillance work conducted before embarking on every surveillance assignment and the techniques used to profile claimants have given us new direction and a starting point that was not available just a few years ago.


Surveillance 101 starts with PREPARATION and PLANNING. The ICU staff takes advantage of all information developed through social media, proprietary databases, location scans, etc., prior to heading out on an assignment.


Investigators must have a solid plan to approach each individual surveillance assignment to maximize results. No two surveillance assignments are alike, just like no two claimants are alike. The characteristics of each individual vary greatly, and planning around a work or school schedule, alleged injuries, where they live, age, relationships, modes of transportation, etc. are all taken into consideration.


Once on-site, the plan must be refined according to the environment. How close are the claimants to any subways or bus stops? Are there additional, unknown vehicles in the driveway? Can you see the house from the street and/or established surveillance position? Can you park on the street anywhere near the home safely or undetected? How many exits does the building have? The list goes on and on.


However, even with all of the resources that ICU has grown with and adapted to, there are some things that you just cannot teach. It takes a special kind of person to conduct surveillance (and truthfully, to conduct any investigation, internally or in the field). Let’s face it; not everyone is cut out for this type of work. Investigators must have the following:


Patience – In each interview process, investigators are asked if they like fishing. If they hate it, they can’t be a surveillance investigator. And why is that? Because it’s all about a waiting game. Investigators spend upwards of 8-12 hours in a vehicle waiting for just one glimpse of a claimant. If you don’t have the patience for it, you will not succeed.


Focus – Maintaining your focus throughout the course of a surveillance assignment is paramount. It only takes a second for a door to open and close. Much can be learned or lost in that moment.


Tenacity – You must be tenacious day in and day out to constantly acquire video on your clients’ behalf. The environment, weather and location of the surveillance are constantly changing from moment to moment, place to place. There are a multitude of outside factors trying to prevent you from acquiring great video – whether it is traffic, a school bus, a traffic cop, a nosy neighbor, a busy parking lot, a crowded subway or an empty subway. You must be tenacious through it all and press on, undetected, to get great video…and we do.


THAT is why we are so selective and meticulous in our hiring process. We vow to provide our clients with quality work, accompanied by unparalleled customer service, and we won’t settle for anything less.

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