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 18, 2013
Former New York Giants Linebacker Indicted By Federal Grand Jury For $1.5 Million Insurance Fraud Scheme (CA) - Marcus Buckley, who played seven seasons for the New York Giants, including 25 starts at linebacker, and Kimberly Jones, a claims adjuster at Gallagher Bassett Services Inc., have been charged with wire fraud and money laundering associated with a $1.5 million scheme to defraud Gallagher Bassett Services. In 2006, Buckley, who was a third-round pick out of Texas A&M in 1993, filed a worker's compensation claim against the Giants for cumulative stress injuries sustained while playing football, in part, in California. After Buckley and the Giants and their insurer settled the Buckley claim for $300,000, Buckley prepared false and fictitious invoices and statements from medical providers for medical services purportedly provided to him from 1999 through 2003. He also prepared false and fictitious credit collection notices from collection agencies purportedly seeking payment for past due medical bills, with services dates from 1999 through 2010. Buckley sent the false and fictitious invoices, statements and credit collection letters to Jones, who had Gallagher Bassett checks made payable to Buckley. In total, Buckley received more than $1,588,000 to which he was not entitled, and used it for various personal expenses. Read more
Lack Of Medical Insurance Led To False Worker's Compensation Claim (OH) - John Burgin has been found guilty of filing a false workers' compensation claim. Investigators found the injury Burgin claimed happened at work actually occurred when he fell through a glass door at home. Additionally, he punched a wall at a hospital two weeks prior to his alleged work injury. Burgin did not immediately seek treatment for the injury at his home because he did not have personal medical insurance. Read more
Insurance Agent Passed Out Phony Certificates of Insurance (GA) - Insurance agent Dennis Avera has been charged with felony insurance fraud. Avera is accused of taking insurance premiums from clients for workers' compensation insurance, while never obtaining the insurance. Instead, he allegedly provided them with fake certificates of insurance. Read more
Pill Mill Doctor Heading To Prison (OH) - Dr. Darrell Hall, who operated EDM Health Services LLC, has pled guilty to one count each of conspiracy to distribute a controlled substance, health care fraud, and failure to account for and pay employment tax and has been sentenced to six years in prison. Hall was found to be prescribing an excessive amount of narcotics, allowing prescriptions to be written by a nurse practitioner, and continuing to prescribe following inconsistent drug screens. The EDM staff would sell prescriptions, write prescriptions based on pill bottles that a patient brought in, or give patients unsigned prescriptions at one office and direct the patients to take them to where Hall was working in order to get them signed. EDM staff were told to use "hot keys" to create fictitious treatment notes for patients not seen or examined. Read more
Post Office Trucking Contractor Decided To Cut Expenses By Ignoring Workers' Comp Insurance Requirement (PA) - Joann Wildeson, the president and co-owner of Horst & Sons Trucking Inc., has been charged with failing to procure workers' compensation insurance for the company's employees while receiving funds from the federal government for that purpose. Wildeson's company operated under contracts with the United States Postal Service in 2008 and 2009, which included the payment of $54,067.85 for workers' compensation insurance. Wildeson told investigators that the policy had been canceled for non-payment and that she had not renewed it because the business was in financial difficulty and she had to cut expenses. Read more
Letter Carrier Arrested For Double-Dipping (MI) - Laurice Poplar, a letter carrier with the United States Postal Service, has been charged by federal authorities with fraud and making false statements in order to obtain federal workers' compensation. Poplar was injured while working as a letter carrier, but she allegedly then worked in a clothing store while receiving her workers' compensation benefits. Read more
Checks For Workers' Compensation Premiums Bounced (OH) - Patsy Krise, dba Sandusky Torching, has pled guilty to workers' compensation fraud for submitting premium payment checks that were returned due to nonsufficient funds. Investigators met with Krise in an attempt to work with her to pay back the more than $1,300 owed for the bounced checks, as well as close the policy as the business had been shut down. However, Krise again failed to remit the appropriate payment. Read more
Fraud Doctor's Son Pleads Guilty To Perjury (TX) - Michael Douglas, the son of Howard T. Douglas, III, M.D., has pled guilty to charges of perjury in the workers' compensation fraud-related investigation of his father. Dr. Douglas was convicted of using his company, Western Medical Evaluators, to overbill Texas Mutual Insurance Company for the time taken to perform functional capacity evaluations for injured workers in Texas. Read more
Supermarket Owner Charged With Money Laundering and Workers' Compensation Fraud in 'Operation Dirty Money' Scheme (FL) - John Diaz, the owner of Diaz Supermarkets, a licensed money service business, and a co-owner of Diavila Enterprises, Inc., which was advertised as a tax preparation company, has been charged with money laundering, organized scheme to defraud, money service business violations, and workers' compensation fraud, and Mercedes Avila-Diaz, the other co-owner of Diavila Enterprises, Inc., has been charged with workers' compensation fraud. Investigators have charged Diaz with conducting $35 million in fraudulent transactions at Diaz Supermarkets, and both have been charged with operating Diavila Enterprises for nearly 10 years without the required workers' compensation coverage. Read more
LPN Underreported Her Earnings In Effort To Increase Her Disability Benefits (OH) - Clareta Fisher has pled no contest to one count of workers' compensation fraud for inappropriately receiving wage loss benefits. Investigators found that Fisher failed to properly report all earnings for her work as a licensed practical nurse in order to receive a higher weekly wage loss benefit. Read more
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