Each week we'll be surveying what the media, state agencies, insurance companies, and others report in terms of workers' comp fraud. Just like a police blotter, our workers' comp fraud blotter lists recent arrests, charges, convictions and investigations.
Workers' Comp Fraud Blotter - April 12, 2012
"The Noodle" Was MMA Fighter While Seeking Workers' Compensation For His Day Job As a Firefighter (CA) - Raphael Davis has been arrested and charged with four felony counts of insurance fraud for workers' compensation insurance claims that he filed between Dec. 2, 2008 to May 20, 2011. Davis, a Los Angeles City firefighter, is alleged to have participated in mixed martial arts fights as "The Noodle" while filing his false workers' compensation claims. Read more
Workers' Comp Fraud Investigator's Conviction for Improperly Accessing Law Enforcement Database Upheld (OH) - The Ohio Court of Appeals has affirmed the conviction of Tonya Claborn for unauthorized use of property, theft in office, and falsification, and remanded the decision to the trial court for resentencing. Claborn, who had access to the Accurint database for her work as a fraud investigator, improperly accessed Accurint to locate information for her private use concerning the drivers of other vehicles who had been in an automobile accident with her. Download the decision
Construction Contractors Shut Down For Labor Law Violations (CT) - The Connecticut Department of Labor's Division of Wage and Workplace Standards has issued stop work orders to 23 companies working at construction project sites. The stop work orders were levied against the companies for misclassifying workers as independent contractors with the intent of avoiding their obligations under federal and state employment laws covering such matters as workers' compensation, unemployment taxes and payroll reporting. The orders resulted in the halting of all activity at the worksites, as well as a $300 civil penalty for each day each company does not carry workers' compensation coverage as required by law. Read more
Businessman Charged With Improperly Billing Government and Insurers For Unneeded Medical Therapy, Equipment and Prescriptions (OH) - John N. Heary, the owner of HealthSource of Medina and Medina Health and Wellness Center, Inc., has been indicted by a federal grand jury for health care fraud, mail fraud, and paying illegal kickbacks. Heary is accused of billing the Ohio Bureau of Workers' Compensation and several insurers for patient physical therapy that was either never provided, was provided in a group setting and therefore should have been billed at a lower reimbursement level, or was provided in lower amounts than what was billed. He is also accused of billing insurers for unnecessary durable medical equipment and billing Medicare in violation of the Anti-Kickback Statute. Read more
More Than Thirty Contractors Arrested For Operating Without Licenses In Undercover Sting (FL) - A sting operation by the Broward County Sheriff's Office, the Broward County Permitting, Licensing and Consumer Protection Division, the Florida Department of Business and Professional Regulation, and the Florida Division of Insurance Fraud has resulted in the arrest of more than thirty individuals for unlicensed contracting for homeowner construction projects. The sting operation was conducted at a foreclosed vacant house. Read more
California Highway Patrol Officer Charged With Workers' Compensation Fraud (CA) -Officer Tony Yao, a five year veteran of CHP, has been arrested on a felony charge of workers' compensation insurance fraud. Yao filed a workers' compensation insurance claim stating that he had injured his back during firearms training at the CHP Academy. Yao told his treating physicians that the back injury was so severe that he was unable to perform even limited duties, including office work. Videotape surveillance, though, showed Yao engaging in various physical activities in direct conflict with his claims, and on the date Yao claimed to have been injured, he was not using the training equipment on which he blamed the injury. Read more
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