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     OIFP Criminal Case Descriptions –
     Insurance Fraud


                Auto                                        scheduled to be sentenced early in
                                                            2004. The remaining defendants are
                Insurance Fraud                             pending trial.

                Altering of Vehicle                         Criminal
                Identification                              Use of “Runners”
                State v.                                    State v.
                Rafael “Bugzy” Ramos,                       Ian Haynes
                Ceaser Labrego, et al.                           On April 15, 2003, an Accusation
                     Investigators from the Office of the   was filed charging Ian Haynes, an East
                Insurance Fraud Prosecutor (OIFP) ar-       Orange police officer, with bribery and
                rested Rafael “Bugzy” Ramos and             corrupt influence for accepting money
                Ceaser Labrego for engaging in a            from a “runner” for East Orange Police
                scheme to sell re-tagged vehicles, in-      Department accident reports. A “run-
                cluding high end luxury vehicles, in        ner” is a person paid by a licensed
                some cases using fraudulently gener-        medical service provider to procure pa-
                ated automobile documentation. A re-        tients for a medical practice so that in-
                tagged vehicle is one in which the Ve-      surance claims can be submitted for
                hicle Identification Number (VIN) has       providing treatment. On May 31, 2003,
                been altered to conceal the identity of     Haynes was admitted into the PTI Pro-
                the rightful owner. Further investigation   gram conditioned upon completing 50
                resulted in a State Grand Jury indict-      hours of community service.
                ment variously charging Rafael
                “Bugzy” Ramos, Ceaser Labrego, Neil         State v.
                Arruda, Hernando Cardoso, Richard           Cyrano Green
                Pina, Manuel Pinto, and Denise Braga              On March 24, 2003, Cyrano Green
                Simao with conspiracy, alterations of       was sentenced to three years in State
                motor vehicle trademarks and identifi-      prison after a jury found him guilty of
                cation numbers, receiving stolen prop-      conspiracy, official bribery, and gifts to
                erty, tampering with public records or      public servants. Green, acting as a
                information, attempted theft and theft      “runner,” conspired with an undercover
                by deception. In a separate indictment,     Newark police officer to provide Green
                Michael Garafalo was charged with re-       with Newark Police Department auto-
                ceiving stolen property.                    mobile accident reports in order to so-
                     On October 9, 2003, Pina pled          licit the persons named in those re-
                guilty to theft by deception and was ad-    ports to become insurance claimants.
                mitted into the Pre-Trial Intervention
                (PTI) Program conditioned upon per-
                forming 50 hours of community service.
                On October 9, 2003, Garafalo pled
                guilty to receiving stolen property and,
                on the same date, was admitted into the
                PTI Program conditioned upon perform-
                ing 50 hours of community service. On
                December 15, 2003, Labrego pled guilty
                to alterations of motor vehicle trade-
                marks and identification numbers. He is




84
State v.                                      time. As a result of the phony accident      ance Company and AIG Claims Ser-
Rajauhn Sharrieff, Shirley                    described in the fictitious police report,   vices, Inc. It also alleged that Dr. Lobo
Jenkins, Abdul Jenkins                        Colonial Penn Insurance Company paid         and Mercy Lobo prepared false patient
and Bernard Zeigler                           approximately $1,563 for alleged prop-       records to reflect that certain health
     On March 31, 2003, a State Grand         erty damage to an automobile. The State      care services were rendered when
Jury returned an indictment charging          also alleged that Zeigler settled a phony    those services were not, in fact, ren-
Rajauhn Sharrieff, Shirley Jenkins,           bodily injury claim, based in part on the    dered, so that phony bills could be
and Abdul Jenkins with conspiracy,            phony accident report, for approximately     submitted to the insurance carriers. All
several counts of bribery in official         $15,000 with Colonial Penn.                  of the claims which formed the basis of
matters, and health care claims fraud.              Zeigler pled guilty to conspiracy,     the health care claims fraud charges
In a separate but related indictment,         health care claims fraud, and theft by       were for services rendered to OIFP
Bernard Zeigler was charged with              deception and was sentenced on Sep-          investigators working undercover as
conspiracy, health care claims fraud,         tember 8, 2003, to two years probation       patients treating at the Pain Manage-
and theft by deception.                       conditioned upon paying $36,563 in res-      ment Clinic. Parkway Insurance paid
The first indictment alleged that, be-        titution to Colonial Penn Insurance Com-     PIP claims totaling approximately
tween February of 1999 and October of         pany and payment of a $3,000 civil in-       $6,481, while AIG Claims Services,
1999, Sharrieff, Shirley Jenkins, and         surance fraud fine. Shirley and Abdul        Inc., paid PIP claims in the approxi-
Abdul Jenkins conspired to pay bribes to      Jenkins pled guilty to conspiracy, bribery   mate amount of $2,150. On September
an East Orange police officer who was         in official matters, and health care         11, 2003, Angel Lobo pled guilty to
working in an undercover capacity for         claims fraud. On October 3, 2003,            health care claims fraud and is sched-
OIFP. The undercover investigation fo-        Shirley Jenkins was sentenced to two         uled to be sentenced early in 2004. On
cused on allegations that persons were        years probation conditioned on serving       October 30, 2003, Mercy Lobo pled
acting as “runners” on behalf of various      90 days in county jail. On the same          guilty to health care claims fraud and
medical service providers to obtain auto-     date, Abdul Jenkins was sentenced to         is also scheduled to be sentenced
mobile accident police reports so that        364 days in county jail as a condition of    early in 2004.
the persons identified in those police re-    three years probation. The case as to
ports could be solicited to become pa-        Sharrieff is pending trial. Sharrieff was
tients of the medical service providers       also named in a separate indictment as
and file automobile PIP insurance             part of the Allied Trauma investigation.
claims. The indictment also alleged that      State v.
the defendants agreed to pay the under-
                                              Dr. Angel Lobo
cover East Orange police officer several
hundred dollars for a genuine East Or-
                                              and Mercy Lobo
ange police automobile accident report,            A State Grand Jury charged Angel
so that the “runners” could coax the per-     Lobo, M.D., and Mercy Lobo with con-
sons identified in those reports to submit    spiracy, health care claims fraud, theft
PIP claims. It also specifically alleged      by deception, criminal use of “runners,”
                                              and falsification of medical records. Dr.
that Sharrieff solicited the undercover po-
                                              Angel Lobo, a licensed medical service
lice officer to create a fictitious automo-
                                              provider, and his office manager, Mercy
bile accident police report in which sev-
                                              Lobo (no relation), operated the medi-
eral people were falsely represented to
                                              cal practice known as Pain Manage-
have been involved in a hit and run auto-
                                              ment Clinic located in Paterson. The
mobile accident that purportedly oc-
                                              indictment alleged that Dr. Lobo and
curred on March 11, 1999, in East Or-
                                              Mercy Lobo paid persons to act as
ange. The accident purportedly involved
                                              “runners” to procure patients for the
four persons who were passengers in
                                              medical practice so that PIP insurance
Sharrieff’s car, though Sharrieff was not
                                              claims for medical services rendered
reported as the driver of the car at that
                                              could be submitted to Parkway Insur-




                                                                                                                                 85
             OIFP Criminal Case Descriptions –
             Insurance Fraud


State v.                                   Chiropractic Licensing Board for           use of “runners.” On October 17, 2003,
Michael Baer                               appropriate licensing action.              he was sentenced to three years in
    A State Grand Jury indicted Dr.                                                   State prison.
Michael Baer for health care claims        State v.
                                           Michael Gardiner                           State v.
fraud, criminal use of “runners,” and
theft by deception. According to the       and Kim Robinson                           Lt. Jerome F. Bollettieri,
indictment, Dr. Baer, a chiropractor            A State Grand Jury indicted           Sgt. Thomas G. DiPatri (ret.),
who owned and operated his own chi-        Michael A. Gardiner, a licensed chiro-     Sgt. Philip N. Ferrari (ret.)
ropractic practice, allegedly submitted    practor, charging him with conspiracy,     and Charles Warrington, II
false PIP insurance claims on behalf       health care claims fraud, theft by de-          In 2002, a State Grand Jury re-
of patients who were undercover in-        ception, and criminal use of a “run-       turned an indictment charging former
vestigators, to Hanover Insurance          ner,” and his office assistant, Kim        Camden Police Department Lt.
Company and Parkway Insurance              Robinson, charging her with con-           Jerome F. Bollettieri and Sgt. Tho-
Company totaling nearly $20,153. The       spiracy and health care claims fraud.      mas G. DiPatri (ret.) with conspiracy,
indictment also alleged that Dr. Baer      The indictment alleged that, between       official misconduct, bribery, and
knowingly used, solicited, or em-          April and July of 2000, Gardiner paid      criminal use of “runners.” At the time
ployed “runners” to procure patients       a person he believed to be a “runner,”     of the conduct alleged in the indict-
for his chiropractic practice. On June     but who was actually an undercover         ment, Bollettieri was the officer in
17, 2003, Baer pled guilty to health       investigator for OIFP, to provide          charge of the Camden Police
care claims fraud and criminal use of      Gardiner with patients for his chiro-      Department’s Traffic Records Bu-
“runners.” He is scheduled to be           practic practice so that he could gen-     reau. According to the indictment,
sentenced early in 2004. The matter        erate PIP insurance claims. The in-        DiPatri, a retired Camden police of-
was also referred to the Chiropractic      dictment also alleged that the under-      ficer, illegally obtained police acci-
Licensing Board for appropriate            cover investigator, posing as a “run-      dent reports from Bollettieri by pay-
licensing action.                          ner,” brought two persons to               ing him bribes. The indictment also
                                           Gardiner’s chiropractic office, both of    alleged that DiPatri obtained the po-
State v.                                   whom Gardiner believed to be pa-           lice accident reports to identify per-
Mohsen Mosslehi                            tients, but who were actually under-       sons who were in automobile acci-
      A State Grand Jury returned an       cover Newark police officers. Accord-      dents in order to solicit prospective
indictment charging Dr. Mohsen             ing to the indictment, Gardiner submit-    patients for treatment at American
Mosslehi with health care claims           ted fictitious PIP insurance claims to     Spinal Care, Inc., (ASC), a
fraud, criminal use of “runners,” and      the GSA Insurance Company, falsely         Collingswood chiropractic facility
theft by deception. According to the in-   claiming that he had provided health       which submitted PIP automobile in-
dictment, Dr. Mosslehi, a chiropractor     care services. The indictment also al-     surance claims to insurance compa-
who owned and operated his own chi-        leged that Kim Robinson knowingly          nies. On August 8, 2003, following a
ropractic practice, allegedly submitted    prepared the fraudulent PIP bills for      six day bench trial, Thomas DiPatri
false PIP insurance claims to Colonial     submission to GSA Insurance Com-           was found guilty of all the charges.
Penn Insurance Company and Park-           pany. The fraudulent billing submitted     On October 3, 2003, DiPatri was
way Insurance Company totaling ap-         by Gardiner and Robinson totaled           sentenced to three years in State
proximately $4,363 on behalf of pa-        approximately $4,980.                      prison. The case as to Bollettieri is
tients who were actually undercover             On March 14, 2003, Robinson pled      pending trial.
investigators. The indictment also al-     guilty to theft by deception. On May 27,
leged that Dr. Mosslehi knowingly em-      2003, she was sentenced to three
ployed “runners” to procure patients       years probation conditioned upon com-
for his chiropractic practice. On Octo-    pleting 190 days of community service,
ber 2, 2003, following a 14 day jury       and ordered to pay a $500 criminal fine
trial in Essex County, Mosslehi was        and a $1,000 civil insurance fraud fine.
acquitted of the charges. The matter,      On July 14, 2003, Gardiner pled guilty
however, was also referred to the          to health care claims fraud and criminal




86
Fraudulent                                were not injured. The first indictment
PIP Insurance Claims                      further alleged that, between May 1,
                                          1998 and October 4, 2000, DiLisio
Involving Health                          and the other defendants submitted
Care Providers                            a dozen false claims to Allstate In-
                                          surance Company, Selective Insur-
State v.                                  ance Company, G.U.F.A.C. Insur-
Franca DiLisio, et al.                    ance Company, and Colonial Penn
     On July 30, 2003, a State Grand      Insurance Company for purported
Jury returned two indictments charg-      chiropractic treatments on 302 sepa-
ing a licensed chiropractic physician     rate dates for patients who had not
and seven other persons variously         appeared for those treatments.
with health care claims fraud, crimi-     Those claims totaled approximately
nal use of “runners,” theft and           $36,380, of which $3,435 had been
attempted theft by deception. One         paid by insurance carriers.
defendant was also charged with                The second indictment charged
misconduct by a corporate official.       Marie Amay, Imaguerite Francois,
All of the charges relate to allega-      Mimose Pierre, Joane Amay, and
tions that the defendants staged ac-      Murielle Francois with health care
cidents for the purpose of submitting     claims fraud and attempted theft by
phony PIP insurance claims to five        deception for acting as passengers
insurance carriers, or that automo-       in staged accidents and generating




bile insurance companies were billed      phony medical treatment claims.
for chiropractic treatments that were     DiLisio allegedly submitted 16 PIP
never rendered.                           insurance claims for these defen-
     The first indictment alleged that,   dants to Allstate Insurance Com-
between May 1, 1998 and October 4,        pany, Selective Insurance Company,
2000, Franca DiLisio, a licensed chi-     Colonial Penn Insurance Company,
ropractor, arranged staged accidents      Crawford Insurance Company, and
with the assistance of Gerard Blanc       Ohio Casualty totaling $65,153.
and Rolando Pierre, who acted as a        None of the 16 PIP claims were paid.
“runner.” It also alleged that the ac-    Some of these cases are also pend-
cidents were staged so DiLisio could      ing in civil court and/or arbitration.
treat the occupants of the vehicles in    The criminal cases of all eight defen-
the staged accidents for injuries they    dants are awaiting trial.
purportedly sustained, and then bill
insurance carriers for PIP insurance
claims even though the patients




                                                                                   87
     OIFP Criminal Case Descriptions –
     Insurance Fraud


                State v.                                 legal patient referral fees (known as
                Lisa Tsilionis, George Tsilionis,        “runners’ fees”) that Lisa and
                Carl Love, Jr., Rajauhn Sharrieff        George Tsilionis paid to Love,
                and Rudolf Hora                          Sharrieff, and Hora as purported
                     On December 11, 2003, a State       transportation costs.
                Grand Jury returned an indictment             The indictment also alleged that
                charging Lisa Tsilionis and her          Love and Sharrieff, through Essex
                former husband, George Tsilionis,        Shuttle, fraudulently billed various in-
                who were both chiropractors and the      surance carriers approximately
                owners and operators of Allied           $5,400 for transportation services
                Trauma and Health Care Center,           that were not rendered. The indict-
                Inc., with conspiracy, health care       ment alleged that Love, who was the
                claims fraud, theft by deception,        president and owner/operator of
                money laundering, and misconduct         Essex Shuttle, Inc., as well as an-
                by a corporate official. The indict-     other patient transportation corpora-
                ment also charged Carl Love, Jr.,        tion operating out of East Orange,
                and Rajauhn Sharrieff, who operated      used his corporations to solicit pa-
                Essex Shuttle, Inc., a transportation    tients for Allied Trauma, acting, in
                company which purportedly trans-         essence, as a “runner.” The indict-
                ported patients to and from medical      ment alleged that, while both of
                appointments, with conspiracy,           these businesses were purportedly
                health care claims fraud, theft by de-   incorporated to transport PIP claim-
                ception, and misconduct by a corpo-      ants to and from treating medical
                rate official. Another defendant,        service providers, Love actually used
                Rudolf Hora, was charged with con-       his corporations to solicit patients for
                spiracy. Love was also separately        Allied Trauma so that automobile in-
                charged with unlawful possession of      surance PIP claims could be submit-
                a weapon.                                ted to insurance companies. Most of
                     According to the indictment, be-    Allied Trauma’s patients were auto-
                tween July of 1996 and March of          mobile accident insurance claimants
                1999, Lisa and George Tsilionis, in      who sought treatment at Allied
                their capacities as owners and op-       Trauma Chiropractic under their au-
                erators of Allied Trauma, Inc.,          tomobile insurance PIP coverage.
                fraudulently billed numerous insur-      The indictment alleged that Love ac-
                ance companies for chiropractic ser-     cepted payments from the
                vices and electro- diagnostic tests      Tsilionises in return for directing pa-
                known as Somatosensory Evoked            tients to Allied Trauma for treatment
                Potentials (SSEP) that they had not      so that false PIP claims could be
                provided. The State also alleged that    submitted to various automobile in-
                the Tsilionises, through Allied          surance companies for diagnostic
                Trauma, fraudulently billed approxi-     tests and other chiropractic treat-
                mately 30 different insurance carriers   ments and services that were not ac-
                over $1.2 million of which approxi-      tually rendered to the patients. Love
                mately $435,000 was paid. The in-        Courier, Essex Shuttle, and Allied
                dictment further alleged that, be-       Trauma all ceased operations follow-
                tween June of 1998 and December          ing the commencement of the
                of 1998, Love and Sharrieff created      State’s investigation in approxi-
                a patient transportation business        mately March of 1999.
                called Essex Shuttle, to disguise il-         As part of the joint investigation
                                                         conducted by OIFP and the Division



88
of Criminal Justice’s Civil Forfeiture   State v.                                 Operation
Unit, bank accounts for Love Cou-        Diane Hughes
rier, Inc., and Essex Shuttle totaling        On February 24, 2003, a             “Give and Go”
approximately $2,800 were frozen         Monmouth County Grand Jury re-
subject to possible forfeiture. Addi-    turned an indictment charging Diane            On June 18, 2003, OIFP ob-
tionally, a lien was filed on Love’s     Hughes with theft by deception, tam-     tained 22 criminal indictments
residence in West Orange, and he         pering with public records, and falsi-   against 38 persons on charges that
subsequently filed for bankruptcy.       fying records. The indictment alleged    they planned or participated in
The State also seized and forfeited      that, on May 7, 2001, Hughes re-         owner-involved automobile thefts,
the Tsilionis home in Bergenfield and    ported to the Eatontown Police De-       otherwise known as automobile
approximately $895,000 in bank ac-       partment and her insurance com-          “give-ups,” in order to collect more
counts they controlled. All defen-       pany, State Farm, that her 2000          than $790,000 in bogus insurance
dants are awaiting criminal trials.      Mazda Millenia had been stolen           claims. As a result of a complex un-
                                         from the Monmouth Mall when her          dercover investigation probing phony
Fraudulent Automobile                    car had actually already been lo-        “owner initiated” automobile “give-up”
                                         cated by New York City police.           insurance claims, these individuals
Theft Claims                                                                      were charged variously with con-
                                         Hughes pled guilty to theft by de-
                                         ception and was admitted into the        spiracy, theft by deception, receiving
State v.                                 PTI Program on July 3, 2003, condi-      stolen property, tampering with pub-
Geuris Valdez-Fernandez                  tioned upon paying restitution in the    lic records or information, false
     On March 14, 2003, Geuris           amount of $20,938 and a $5,000           swearing, alterations of motor ve-
Valdez-Fernandez was entered into        civil insurance fraud fine. She was      hicle identification numbers, and
the PTI Program for 36 months con-       also ordered to perform 75 hours of      simulating a motor vehicle insurance
ditioned upon paying restitution to      community service.                       identification card.
Newark Insurance Company in the                                                         OIFP initiated this undercover in-
amount of $10,154 and a civil insur-                                              vestigation in order to address the in-
                                         State v.
ance fraud fine of $4,000. Valdez-                                                creasing problem of automobile theft
                                         Diana Fonseca
Fernandez previously pled guilty to                                               and automobile insurance “give-ups”
                                              On April 11, 2003, Diana
an Accusation charging him with                                                   in North Jersey. OIFP investigators,
                                         Fonseca was sentenced to three
conspiracy. Valdez-Fernandez ad-                                                  working undercover, leased a garage
                                         years probation conditioned upon
mitted that, on October 17, 2001, he                                              on Tonnele Avenue in Jersey City
                                         paying restitution in the amount of
voluntarily gave his 1998 Toyota                                                  and, in the guise of an auto repair fa-
                                         $13,527 to Liberty Mutual, a $5,000
Camry to another individual for the                                               cility, spread the word that anyone
                                         civil insurance fraud fine, and com-
purpose of disposing of the vehicle                                               who owned or leased a car and
                                         pleting 100 hours of community ser-
in order to have the insurance com-                                               wanted to get rid of it to avoid further
                                         vice. Fonseca pled guilty to an Ac-
pany pay off the outstanding loan ob-                                             car payments or lease payments, or
                                         cusation charging her with theft by
ligation and to avoid continued auto-                                             because the car was damaged or
                                         deception. Fonseca admitted that,
mobile payments.                                                                  needed expensive repairs, could “give
                                         on July 27, 2001, she falsely re-
                                         ported her vehicle stolen in order to    it up” at the facility or to the facility
                                         submit a fraudulent stolen vehicle       operators. An automobile “give-up” is
                                         claim to Liberty Mutual Insurance        the term given by insurance fraud
                                         Company. Liberty Mutual paid the         investigators to the voluntary trans-
                                         claim totaling $13,130 to Fonseca        fer of an automobile by the owner to
                                         and the lien holder. She also admit-     another person who then disposes
                                         ted that she arranged to have an-        of the vehicle, often for a cash pay-
                                         other person dispose of her vehicle      ment, for the purpose of allowing
                                         so that she could submit the fraudu-     the owner to file a false auto insur-
                                         lent insurance claim.                    ance theft claim with his automo-
                                                                                  bile insurance carrier and collect




                                                                                                                              89
              OIFP Criminal Case Descriptions –
              Insurance Fraud


insurance money for the phony              of the investigation were returned to       Martinez pled guilty to receiving stolen
theft, or to have his car loan or car      the insurance companies or to the le-       property, namely, a stolen Cadillac
lease paid off by the insurance carrier.   gitimate holder of title to the car.        Escalade. On November 7, 2003, he
     In the course of the investigation,   Restitution for the amount of claims        was admitted into the PTI Program
State Investigators recovered 46           money paid may be sought from the           conditioned upon performing 60 hours
cars and SUVs from several persons         defendants in court.                        of community service. On November
who acted as “middlemen” and re-                Two of the defendants identified       17, 2003, Gilberto Pasqual pled guilty
ceived the “give-up” automobiles           during this undercover investigation,       to receiving stolen property. He is
from their owners so that the cars         Ryan December and Jason Decem-              scheduled to be sentenced early in
could be falsely reported stolen. Un-      ber, had been previously arrested on        2004. Edward G. Whyte pled guilty to
dercover State Investigators also re-      January 12, 2003 by OIFP investiga-         receiving stolen property on Septem-
ceived some vehicles directly from         tors. Ryan December was charged             ber 29, 2003. On November 14, 2003,
the owners themselves. The total           with conspiracy and receiving stolen        he was admitted into the PTI Pro-
market value of all the vehicles re-       property, and Jason December was            gram conditioned upon performing 60
covered by OIFP investigators ex-          charged with conspiracy. Arrest war-        hours of community service.
ceeded $1 million. More than 32            rants were issued for nine of the 38             Whyte was charged with pos-
phony automobile insurance theft           defendants, including Richard Ruiz,         sessing a stolen 2003 Mercedes
claims stemming from the sting were        Carmen Marchitello, Anthony                 Benz on December 20, 2002 that
submitted to 21 insurance carriers,        Marchitello, Gilberto Pascual, Rafael       was stolen from a Mercedes Benz
including First Trenton Indemnity,         Padilla, Jason December, Juan               dealership located in Plumstead,
Ohio Casualty Insurance Company,           Naut, Alex Carvalho, and Guillermo          Pennsylvania, by means of a “key
Allstate Insurance Company, Metro-         Guzman a/k/a “Junior.” Nineteen of          swap.” A “key swap” theft occurs
politan Property and Casualty, New         the defendants were issued sum-             when a person, posing as a cus-
Jersey Manufacturers Insurance             monses. Some of the defendants in-          tomer, enters an automobile dealer-
Company, Progressive Insurance             dicted as a result of this undercover       ship and takes a test drive. During
Company, Liberty Mutual Insurance          operation were charged with “re-tag-        the test drive, the genuine ignition
Company, State Farm Insurance              ging” three vehicles. A “re-tagged”         key is “swapped” for a fake key, and
Company, Hanover Insurance Com-            vehicle is a car whose VIN has been         later the car is stolen by using the
pany, Prudential Insurance Com-            altered in order to conceal the true        genuine ignition key. Of the nine per-
pany, USAA Insurance Company,              identity of the car and its owner, as       sons for whom arrest warrants were
State and Country Fire Insurance           well as the fact that it has been           issued, six were arrested by OIFP
Company, AIG Insurance Company,            “given- up,” all to facilitate fraudu-      investigators on June 24, 2003. The
Rutgers Casualty Insurance Com-            lent auto theft insurance claims.           six persons arrested were Richard
pany, Travelers Insurance Company,         Two of the defendants who were al-          Ruiz, Carmen Marchitello, Anthony
Selective Insurance Company, Erie          legedly involved in automobile re-          Marchitello, Jason December,
Insurance Company, Penn National           tagging conduct, Rafael “Bugzy”             Guillermo Guzman, and Juan Naut.
Insurance Company, Motors Insur-           Ramos and Ceaser Labrego, were              While conducting these arrests,
ance Company, Sompo Japan Insur-           previously arrested in August of            OIFP investigators also arrested Luis
ance Company of America, and Uni-          2002 by OIFP investigators and              Flores, a fugitive from the Essex
versal Underwriters Insurance Com-         charged with conspiracy to commit           County Sheriff’s Office who was be-
pany. Carriers paid approximately          altering motor vehicle trademarks           ing sought on unrelated charges. On
$791,094 for these phony auto insur-       and conspiracy to commit posses-            December 5, 2003, Guillermo
ance theft claims. Another $48,056         sion of altered property.                   Guzman pled guilty to the attempted
in insurance claims were not paid ei-           Also, as part of this investigation,   theft by deception count of the indict-
ther because the insurance company         three of the defendants charged with        ment and is scheduled to be sen-
was suspicious of the claim or be-         receiving stolen property and simu-         tenced early in 2004. Guzman also
cause OIFP’s investigation inter-          lating a motor vehicle insurance            pled guilty on December 5, 2003, to
rupted the claims process. Forty-six       identification card, pled guilty. On        an unrelated Accusation which
cars obtained by OIFP in the course        September 2, 2003, Joaquin




90
charged him with attempted theft by      2000, Lowery conspired with
deception. Guzman admitted that on       Tomassini and Gonzalez to dispose of
August 4, 2001, he reported his 1984     Lowery’s 1988 Chevrolet Corvette, val-
Oldsmobile Cutlass stolen in             ued at approximately $8,000, so that
Secaucus. He submitted a theft           Lowery could file a fraudulent stolen
claim to Prudential Insurance Com-       vehicle claim with his insurance com-
pany supported by various fraudulent     pany. It is alleged that Gonzalez re-
invoices indicating that he had a        moved the vehicle from Lowery’s place
$1,000 stereo system and $850            of business using a flatbed tow truck
worth of rims and tires recently in-     and gave the keys to the Corvette to
stalled in the car. Guzman admitted      Tomassini, who subsequently re-
that the invoices were phony and the     turned the keys to Lowery.
stereo system, rims and tires had not         According to the indictments, on
actually been installed. Guzman will     January 17, 2000, Lowery filed a
also be sentenced for this matter        false stolen vehicle report with the
early in 2004.                           Perth Amboy Police Department. It
                                         is further alleged that on January
                                         19, 2000, Lowery submitted a




State v.                                 fraudulent stolen vehicle insurance
Robert Lowery, Carlos Gonzalez           claim with CNA Insurance Com-
and Antonio Tomassini                    pany. On October 16, 2003,
     On August 1, 2003, a Middlesex      Gonzalez was admitted into the PTI
County Grand Jury returned sepa-         Program conditioned upon paying
rate indictments against three defen-    standard fines in the amount of
dants involved in an automobile “give-   $125. The case as to the remaining
up” scheme. The first indictment         defendants is pending trial.
charged Robert Lowery with con-
spiracy, attempted theft by deception,
and tampering with public records or
information. The second indictment
charged Carlos Gonzalez with con-
spiracy and attempted theft by decep-
tion, and the third indictment charged
Antonio Tomassini with conspiracy
and attempted theft by deception. The
indictments alleged that on January 4,




                                                                                  91
              OIFP Criminal Case Descriptions –
              Insurance Fraud

“Give and Go” Guilty Pleas
     Defendant           Charges                           Plea       Sentence      Sentence
                                                           Date       Date

     Thomas Wasso        Conspiracy - 3rd Degree           8/22/03    11/14/03      (3rd Degree Conspiracy)
                         Theft by Deception - 3rd Degree
                                                                                    2 years probation;
                                                                                    $30,220.45 restitution

     Luis Trabal         Conspiracy - 3rd Degree           9/22/03    11/14/03      (3rd Degree Theft by Deception)
                         Theft by Deception - 3rd Degree
                         Tampering with Public Records                              2 years probation;
                         or Information - 3rd Degree                                $33,723.80 restitution

     Nidia Munoz         Conspiracy - 3rd Degree           9/30/03    11/21/03      (3rd Degree Tampering with
                         Theft by Deception - 3rd Degree                            Public Records or Information)
                         Tampering with Public Records
                         or Information - 3rd Degree                                3 years probation;
                                                                                    $19,526 restitution

     Carlos M. Grullon   Conspiracy - 3rd Degree           10/24/03   12/12/03      (3rd Degree Theft by Deception)
                         Theft by Deception - 3rd Degree
                         Tampering with Public Records                              Sentenced to 4 years probation;
                         or Information - 3rd Degree                                $16,520 restitution; $5,000 civil fine;
                                                                                    200 hours community service

     Aldemar Palacios    Conspiracy - 3rd Degree           10/24/03   12/12/03      (3rd Degree Theft by Deception)
                         Theft by Deception - 3rd Degree
                         Tampering with Public Records                              3 years probation; $3,000 civil fine;
                         or Information - 3rd Degree                                150 hours community service

     Ysrael Tavarez      Conspiracy - 3rd Degree           10/17/03   12/12/03      (3rd Degree Attempted Theft by Deception)
                         Attempted Theft by Deception
                         - 3rd Degree                                               Admitted into PTI; $5,000 civil fine;
                         Tampering with Public Records                              50 hours community service
                         or Information - 3rd Degree

     Luigi Andriano      Conspiracy - 3rd Degree           10/17/03   12/8/03       (3rd Degree Conspiracy)
                         Theft by Deception - 3rd Degree              (Postponed)
                                                                                    Pending sentencing

     Renee Perez         Conspiracy - 3rd Degree           10/24/03   1/13/04       (3rd Degree Attempted Theft
                         Attempted Theft by Deception                               by Deception)
                         - 3rd Degree
                         Tampering with Public Records                              1 year probation; $250 criminal fine
                         or Information - 3rd Degree




92
Defendant          Charges                                Plea       Sentence   Sentence
                                                          Date       Date


Richard Pina       Theft by Deception - 3rd Degree        10/9/03    10/9/03    (3rd Degree Theft by Deception)
                   Tampering with Public Records
                   or Information - 3rd Degree                                  Admitted into PTI; 50 hours
                                                                                community service

Michael Garafalo   Receiving Stolen Property              10/9/03    10/9/03    (Receiving Stolen Property - 3rd Degree)
                   - 3rd Degree
                                                                                Admitted into PTI;
                                                                                50 hours community service

Joaquin Martinez   Receiving Stolen Property
                   - 3rd Degree
                   Simulating a Motor Vehicle Insurance   9/2/03     11/7/03    (3rd Degree Receiving Stolen Property)
                   Identification Card - 4th Degree
                                                                                Admitted into PTI;
                                                                                60 hours community service

Edward G. Whyte    Receiving Stolen Property              9/29/03    11/14/03   (Receiving Stolen Property - 3rd Degree)
                   - 3rd Degree
                                                                                Admitted into PTI; 60 hours
                                                                                community service

Gilberto Pasqual   Conspiracy - 3rd Degree                11/17/03   1/16/04    (Receiving Stolen Property - 3rd Degree)
                   Theft by Deception - 3rd Degree
                   Receiving Stolen Property                                    3 years State prison
                   - 3rd Degree

Maria A. Mora      Conspiracy - 3rd Degree`               11/20/03   1/23/04    (Theft by Deception - 3rd Degree)
                   Theft by Deception - 3rd Degree
                   Tampering with Public Records                                5 years probation;
                   or Information - 3rd Degree                                  $11,342.70 restitution

Gary Albanese      Conspiracy - 3rd Degree                12/5/03    1/23/04    (Conspiracy - 3rd Degree)
                   Theft by Deception - 3rd Degree
                                                                                2 years probation; $250 criminal
                                                                                fine; full restitution

Guillermo Guzman Conspiracy - 3rd Degree                  12/5/03    1/23/04    (Attempted Theft by Deception
                 Attempted Theft by Deception                                   - 3rd Degree)
                 - 3rd Degree
                                                                                2 years probation; $200 criminal fine




                                                                                                                           93
     OIFP Criminal Case Descriptions –
     Insurance Fraud


                State v.                                  his insurance carrier, Allstate Insur-
                Omar K. Gordon                            ance Company. On October 31, 2003,
                    On August 5, 2003, a Hudson           Cirino was sentenced to two years
                County Grand Jury charged Omar K.         probation and ordered to pay
                Gordon with attempted theft by de-        a $3,500 civil insurance fraud fine. On
                ception, tampering with public            December 10, 2003, a State Grand
                records or information, and falsifying    Jury returned an indictment charging
                records. According to the indictment,     Halpin with conspiracy, arson for hire,
                on August 24, 2001, Omar Gordon           aggravated arson, arson to collect in-
                reported to the Jersey City Police        surance proceeds, and theft by de-
                Department that his 1996 Nissan           ception. Halpin’s case is pending trial.
                Maxima had been stolen from the
                Jersey City Pep Boys parking lot.         State v.
                The indictment also alleged that on       Husam A. Hamdan
                September 24, 2001, Gordon sub-                On September 15, 2003,
                mitted an Affidavit of Vehicle Theft to   Husam Hamdan pled guilty to an
                State Farm Insurance Company              Accusation charging him with con-
                claiming that he last saw his vehicle     spiracy. Hamdan admitted that on
                on August 23, 2001, in the Pep Boys       June 1, 2003, he offered to pay a
                parking lot and reported it missing on    co-conspirator to take Hamdan’s
                August 24, 2001. The State intends        1994 Mazda 626 and dispose of it
                to prove that, because New York City      so that he could file a fraudulent
                Police Department Detective Ken-          stolen vehicle insurance claim with
                neth DeStefano recovered Gordon’s         American International Insurance
                vehicle in the Bronx, New York, on        Company of New Jersey. Hamdan
                August 23, 2001, it could not have        also admitted that after he turned
                been in the Pep Boys parking lot as       over the vehicle to his co-conspira-
                reported by Gordon. His case is           tor, he filed a stolen vehicle report
                pending trial.                            with the East Orange Police Depart-
                                                          ment. On November 21, 2003,
                State v.                                  Hamdan was admitted into the PTI
                Joseph Cirino, Jr.                        Program conditioned on performing
                     On August 18, 2003, Joseph           50 hours of community service.
                Cirino pled guilty to an Accusation
                charging him with arson of property       State v.
                for the purpose of collecting insur-      Harold Davis
                ance proceeds. Cirino admitted that,          On March 24, 2003, Harold
                on November 2, 2002, he met a per-        Davis pled guilty to an Accusation
                son identified as Robert Halpin in the    charging him with attempted theft by
                WalMart parking lot located in Berlin,    deception. Davis, an Atlantic City ca-
                New Jersey, and gave him his 2000         sino employee, admitted that, on
                Honda Accord along with $500, in          September 27, 2001, he submitted a
                order for Halpin to take Cirino’s car     false automobile insurance claim to
                to an undisclosed location and set it     Rutgers Casualty, claiming that he
                on fire. Cirino planned to discontinue    had driven his car into New York City
                his lease payments and file a fraudu-     on September 11, 2001, and that it
                lent insurance claim. Cirino admitted     sustained damage from falling debris
                that he reported the vehicle stolen       from the terrorist attacks on the
                and submitted a fraudulent claim to       World Trade Center Towers. The in-




94
vestigation revealed that Davis and his   Street in Trenton. It was determined     State v.
car were at his place of employment       that there was no evidence that the      Trisha Townsend
in Atlantic City on September 11,         vehicle had been stolen and that the          Trisha Townsend was charged by
2001, and, therefore, that his car        fire was the result of arson. Because    a Mercer County Grand Jury with at-
could not have sustained damage in        of the suspicious nature of Davis’       tempted theft by deception. According
New York City as he claimed. Davis        theft claim, Liberty Mutual denied the   to the indictment, on May 26, 2001,
admitted that the damage to his ve-       claim and referred it to OIFP. Davis     Townsend falsely reported to the Tren-
hicle was caused by highway debris.       was sentenced to two years proba-        ton Police Department that her 1994
Davis was admitted into the PTI Pro-      tion conditioned upon paying a           Dodge Intrepid had been stolen and
gram on May 1, 2003, conditioned          $3,000 civil insurance fraud fine.       filed a fraudulent auto theft claim with
upon performing 75 hours of com-                                                   her insurance company, New Jersey
munity service and paying a $2,500        State v.                                 Manufacturers Insurance Company,
civil penalty.                            Anna M. White                            four days later. On January 27, 2003,
                                               A Cumberland County Grand           Townsend was admitted into the PTI
State v.                                  Jury returned an indictment charging     Program conditioned upon payment of
Donald Bracco                             Anna M. White with falsifying            a $5,000 civil insurance fraud fine.
     Donald Bracco pled guilty to an      records. According to the indictment,
Accusation charging him with tam-         on June 2, 2001, White submitted a       State v.
pering with public records or infor-      falsified Affidavit of Theft for her     Vincent Torrone
mation. Bracco admitted that, on No-      1992 Dodge Caravan to Ohio Casu-              On March 18, 2003, a Bergen
vember 30, 2001, he submitted a           alty Insurance Company in conjunc-       County Grand Jury returned an in-
false report with the Old Bridge Po-      tion with a fraudulent insurance         dictment charging Vincent Torrone
lice Department claiming that his         claim. White had, in fact, loaned her    with attempted theft by deception.
2001 Ford Explorer, which he was          van to another person who was then       According to the indictment, on Feb-
leasing from Ford Motor Credit, had       involved in an accident. White           ruary 1, 2001, Torrone, owner of the
been stolen. Bracco knew that the         wanted the insurance carrier to be-      Import Specialist, a Paramus auto
vehicle had not been stolen, but, in      lieve her car was damaged after it       repair shop, reported to the Paramus
fact, had been abandoned in               was purportedly stolen. On February      Police Department that his 1992
Marlboro, where it had been recov-        3, 2003, White pled guilty to falsify-   Mercury Grand Marquis had been
ered by the Marlboro Police Depart-       ing records. On April 25, 2003, she      stolen the day before from his place
ment. On March 24, 2003, Bracco           was admitted into the PTI Program        of business. On the same date,
was sentenced to three years in           conditioned upon performing 30           Torrone allegedly submitted a ve-
State prison, ordered to pay restitu-     hours of community service.              hicle theft claim to the Motor Club of
tion in the amount of $584, and                                                    America (MCA) in the approximate
agreed to pay a $5,000 civil insur-                                                amount of $4,325. MCA denied the
ance fraud fine.                                                                   claim and referred the matter to
                                                                                   OIFP for investigation. The State in-
State v.                                                                           tends to prove that the 1992 Mercury
Ernest Davis                                                                       Grand Marquis which Torrone alleg-
    On February 20, 2003, Ernest                                                   edly reported stolen on February 1,
Davis pled guilty to an Accusation                                                 2001, was actually recovered by the
charging him with attempted theft by                                               New York Police Department on
deception. Davis admitted that, on                                                 January 28, 2001, in New York City,
December 5, 2001, he filed a false                                                 thus casting doubt on the veracity of
automobile theft claim with his insur-                                             Torrone’s report. Torrone’s case is
ance company, Liberty Mutual,                                                      scheduled for trial early in 2004.
claiming that his 1998 Toyota Avalon
had been stolen on November 26,
2001, when Trenton police found
Davis’ Toyota in flames on Broad




                                                                                                                              95
     OIFP Criminal Case Descriptions –
     Insurance Fraud


                State v.
                Angel Rodrigo                            State v.
                     On February 28, 2003, Angel         Michael Scarpa
                Rodrigo pled guilty to an Accusation          On May 13, 2003, a Hudson
                charging him with falsifying or tam-     County Grand Jury returned an indict-
                pering with records. Rodrigo admit-      ment charging Michael Scarpa with
                ted that on September 11, 2001, he       attempted theft by deception, tamper-
                fraudulently submitted an Affidavit of   ing with public records or information,
                Vehicle Theft claim to New Jersey        and falsifying records. According to
                Citizens United Reciprocal Ex-           the indictment, on December 22,
                change, claiming that his 2000           2001, Scarpa reported to the Jersey
                Mercedes-Benz C280 had been sto-         City Police Department that his 1992
                len on September 2, 2001. The in-        Chevrolet Suburban had been stolen
                vestigation revealed that the vehicle    from the Hudson Mall in Jersey City.
                had been recovered by the Hillside       On December 26, 2001, Scarpa sub-
                Township Police Department on Au-        mitted a stolen automobile claim with
                gust 28, 2001, four days prior to the    State Farm Insurance Company for
                time Rodrigo reported last seeing the    $11,103, the value of the insured car
                Mercedes Benz. On May 16, 2003,          at the time of the claim. State Farm
                Rodrigo was sentenced to three           denied the claim and referred the mat-
                years probation conditioned upon         ter to OIFP for investigation. The OIFP
                completing 100 hours of community        investigation revealed that, unbe-
                service and paying restitution in the    knownst to Scarpa, on December 18,
                amount of $2,279 as well as a            2001, four days prior to Scarpa’s sto-
                $2,500 civil insurance fraud fine.       len vehicle report to the Jersey City
                                                         Police Department, his 1992 Chevrolet
                State v.                                 Suburban had been “tagged” in the
                Wendy Montalvo                           Bronx, New York, as a “derelict” ve-
                     On April 1, 2003, Wendy             hicle and, on December 19, 2001, the
                Montalvo pled guilty to an Accusa-       Suburban was removed and crushed
                tion charging her with tampering with    by the New York City Sanitation De-
                public records or information.           partment. Scarpa pled guilty to at-
                Montalvo admitted that, on May 3,        tempted theft by deception and, on
                2002, she falsely reported to the        November 7, 2003, he was sen-
                Kearny Police Department that her        tenced to one year probation with the
                2001 Honda Civic had been stolen in      conditions that he pay a $5,000 civil
                order to submit a fraudulent stolen      insurance fraud fine and perform 100
                vehicle theft claim to Liberty Mutual    hours of community service.
                Insurance Company. On May 14,
                                                         State v.
                2003, Montalvo was admitted into
                the PTI Program conditioned upon
                completing 25 hours of community
                service and paying a $5,000 civil in-
                surance fraud fine.




96
Jorge L. Velazquez                         State v.                                    theft claim. However, OIFP’s investi-
     On June 19, 2003 Jorge                Julio Arenas                                gation revealed that two weeks prior to
Velazquez pled guilty to an Accusa-             On May 13, 2003, a complaint           the purported October 14, 1999 theft
tion charging him with tampering           summons was issued to Julio Are-            date, the car had been involved in a
with public records or information.        nas charging him with attempted             police chase and abandoned in the
Velazquez admitted that, on Decem-         theft by deception. The complaint al-       City of Camden. The investigation fur-
ber 25, 2002, he falsely reported to       leged that in December of 2001, Are-        ther revealed that the Camden Police
the Elizabeth Police Department that       nas falsely reported his 1998               Department impounded the car and
his 1999 Ford Contour had been sto-        Cadillac Catera stolen to the Newark        that it was towed to a garage in
len so that he could submit a false        Police Department and subsequently          Pennsauken where it remained until
auto insurance theft claim. He admit-      filed a phony vehicle theft insurance       June 18, 2001. On July 24, 2003,
ted that he had actually been in-          claim with Liberty Mutual. Arenas           Smith pled guilty to theft by decep-
volved in a hit-and-run accident in        subsequently admitted that the              tion and was sentenced to two years
Linden involving a parked car, fled        Cadillac had not been stolen, but           probation, conditioned on serving 64
the scene and abandoned the car in         that he had voluntarily destroyed the       days in county jail, and payment of
another location. He filed a vehicle       vehicle by setting it on fire, as part of   $9,000 in restitution to the Allstate In-
theft insurance claim with Prudential      a scheme to steal insurance money           surance Company. He was also or-
Insurance Company, but subse-              from Liberty Mutual and avoid further       dered to pay a $5,000 civil insurance
quently withdrew the insurance             expensive car payments. Liberty Mu-         fraud fine.
claim. On August 15, 2003,                 tual denied the claim. On June 24,
Velazquez was admitted into the PTI        2003, Arenas pled guilty to an Accu-        State v.
Program conditioned upon perform-          sation charging him with the crime.         James Good
ing 60 hours of community service          He was admitted into the PTI Pro-                 On October 30, 2003, James
and paying a $5,000 civil insurance        gram on August 15, 2003, condi-             Good was charged by an Essex
fraud fine.                                tioned upon performing 50 hours of          County Grand Jury with falsifying
                                           community service.                          records. According to the indictment,
State v.                                                                               on January 10, 2002, Good filed a
Mariusz Kwiatkowski                        State v.                                    stolen vehicle claim with his insur-
     On June 30, 2003, Mariusz             Robert E. Smith                             ance carrier, Liberty Mutual Insur-
Kwiatkowski pled guilty to an Accu-             A Burlington County Grand Jury         ance Company, stating that his 1989
sation charging him with tampering         returned an indictment charging             Subaru had been stolen, even
with public records or information.        Robert E. Smith with theft by decep-        though he knew that the vehicle had
Kwiatkowski admitted that, on Janu-        tion, unsworn falsification to authori-     not been stolen and that he was not
ary 11, 2003, he lost control of his       ties, and falsifying or tampering with      entitled to the insurance money. The
2003 Nissan, hitting a parked car.         records. According to the indictment,       State intends to prove that, on Octo-
Following the accident, Kwiatkowski        sometime between October 14, 1999           ber 12, 2001, Good’s 1989 Subaru
fled the scene. Kwiatkowski falsely        and November 22, 1999, Smith re-            was involved in an automobile acci-
reported to the Lawrence Police De-        ported to the Moorestown Police De-         dent in Newark in which the driver
partment that his Nissan had been          partment that his former wife’s 1994        and a passenger fled the scene. It is
stolen and filed a fraudulent automo-      Saab 900 had been stolen from the           alleged that Good submitted the
bile theft claim with Liberty Mutual In-   Moorestown Mall parking lot on Oc-          false claim with Liberty Mutual in or-
surance Company to cover the dam-          tober 14, 1999. The indictment fur-         der to cover up for the person driving
age done to the car in the accident.       ther alleged that, on October 26,           the car because she had wrongfully
On September 17, 2003,                     1999, Smith signed and submitted            left the scene of the accident. His
Kwiatkowski was admitted into the          an affidavit of theft to Allstate Insur-    case is pending trial.
PTI Program conditioned upon per-          ance Company falsely stating that           State v.
forming 75 hours of community ser-         the vehicle had been stolen from the
vice and paying a $5,000 civil insur-      Moorestown Mall, causing Allstate to
ance fraud fine.                           pay approximately $12,000 on the




                                                                                                                                   97
     OIFP Criminal Case Descriptions –
     Insurance Fraud


                Jorge A. Salamanca                       Martino A. Cartier
                     On October 28, 2003, Jorge               On October 14, 2003, Martino
                Salamanca pled guilty to an Accusa-      Cartier pled guilty to an Accusation
                tion charging him with tampering         charging him with theft by deception.
                with public records or information.      Cartier admitted that, in September
                Salamanca admitted that, on June         of 2001, he brought his 2000
                11, 2002, he falsely reported to the     Chrysler Sebring to a body shop in
                Elizabeth Police Department that his     Philadelphia for repairs. When
                1996 Acura had been stolen. He also      Cartier was unable to pay the re-
                admitted that he filed a fraudulent      maining mechanic’s lien on the ve-
                stolen car insurance claim with          hicle, he conspired with the body
                Allstate Insurance. He represented       shop repair man to abandon the car
                to Allstate that he last saw his ve-     at Penn Station in Philadelphia.
                hicle at 5:30 p.m. on June 9, 2002, in   Cartier then falsely reported his car
                Elizabeth, New Jersey. However, the      stolen to Allstate Insurance Com-
                vehicle was found at 1:30 a.m. on        pany, which paid the lien holder
                June 10, 2002, in Miami, Florida,        $19,370. On December 1, 2003,
                which would have made it impos-          Cartier was admitted into the PTI
                sible for him to have seen his car at    Program conditioned on paying resti-
                the time and date in Elizabeth that      tution in the amount of $19,327.
                he claimed. Allstate denied the claim
                and referred the matter to OIFP.         State v.
                Salamanca is scheduled to be sen-        Modesta Vendittoli
                tenced early in 2004.                         On December 9, 2003, a State
                                                         Grand Jury returned an indictment
                State v.                                 charging Modesta Vendittoli with at-
                Lojza Gruevski                           tempted theft by deception and tam-
                     On October 17, 2003, Lojza          pering. According to the indictment,
                Gruevski pled guilty to an Accusa-       on January 28, 2002, Vendittoli re-
                tion charging her with attempted         ported to the Secaucus Police De-
                theft by deception. Gruevski admit-      partment that her 1999 Acura had
                ted that, on May 4, 2001, she falsely    been stolen from the Harmon
                reported to Allstate Insurance Com-      Meadow Plaza parking lot in
                pany that her 1995 Nissan Path-          Secaucus while she was inside
                finder had been stolen the previous      shopping. Allegedly, Vendittoli also
                day in New York City, in order to        reported the purported theft to her in-
                conceal the fact that her uninsured      surance carrier, First Trenton Indem-
                son had been driving the car and         nity Insurance Company. The State
                was involved in an automobile acci-      intends to prove that Vendittoli’s
                dent in New York City. Allstate de-      Acura had, in fact, been impounded
                nied the claim and referred the mat-     by the Jersey City Police Department
                ter to OIFP for investigation.           on January 19, 2002, nine days prior
                Gruevski was admitted into the PTI       to the reported theft in Secaucus.
                Program conditioned on performing        Vendittoli’s case is pending trial.
                25 hours of community service.

                State v.




98
Other Fraudulent                          made payable to Johnson and             State v.
                                          Jefferson Loan Company as a result      Peter Mangiola
Automobile Related
                                          of a vehicle theft claim submitted by        On February 10, 2003, Peter
Insurance Claims                          Johnson in November 1999, in which      Mangiola pled guilty to an Accusa-
                                          he claimed his 1990 Acura had been      tion charging him with attempted
State v.                                  stolen. Johnson was supposed to         theft by deception. Mangiola admit-
Narenda Solanki                           endorse the check over to Jefferson     ted that, on October 17, 1996, he
     Narenda Solanki pled guilty in       Loan Company to pay the balance of      fraudulently reported to General Ac-
2002 to an Accusation charging him        the loan that Johnson owed on the       cident Insurance Company that sev-
with falsifying records. Solanki admit-   Acura. Instead, Johnson cashed the      eral items, including a Nikon camera
ted that, on May 29, 1998, he falsely     check and kept the money for his        and a pair of Ray Ban sunglasses,
reported to the North Brunswick Po-       own use. On June 17, 2003,              had been stolen from his automobile.
lice Department that his car had          Johnson pled guilty to uttering a       Mangiola submitted two fraudulent
been burglarized and that approxi-        forged document and on September        credit card receipts as proof of the
mately $8,000 in cash and gift items      4, 2003, he was sentenced to three      value of the camera and sunglasses
were stolen from the vehicle. Solanki     years probation conditioned upon pay-   and General Accident paid his claim
also admitted that he made a theft        ing restitution to the Jefferson Loan   in the amount of $1,277. Mangiola
claim to State Farm Insurance Com-        Company in the amount of $2,173.        also admitted that, on May 5, 1999,
pany in the amount of $8,000 and, in                                              he submitted the same two fraudu-
order to support his claim, submitted     State v.                                lent receipts to Hanover Insurance
phony receipts that were provided to      Daniel Pascuite                         Company, reporting that the same
him by Timetron Watch Company lo-              On March 12, 2003, Daniel          items, along with clothing and com-
cated in Edison. On March 28, 2003,       Pascuite pled guilty to an Accusation   puter equipment valued at $5,921,
Solanki was admitted into the PTI         charging him with attempted theft by    were stolen from his car. Hanover
Program and ordered to pay a              deception. Pascuite admitted that, on
$5,000 civil insurance fraud fine.        December 16, 2000, he falsely re-
The investigation is continuing and       ported to Clarendon National Insur-
further civil or criminal insurance       ance Company that the rims and
fraud penalties against other per-        tires from his 1999 Chevrolet Cor-
sons who may have assisted                vette had been stolen. He also ad-
Solanki are pending.                      mitted that, on May 10, 2001, he
                                          submitted altered receipts to the in-
State v.                                  surance company in order to steal
Alloy Johnson                             claim money to which he was not en-
     On January 2, 2003, a Middlesex      titled. On July 16, 2003, Pasciute
County Grand Jury handed up an in-        was admitted into the PTI Program
dictment charging Alloy Johnson with      with the condition that he perform 50
theft by deception and forgery. Ac-       hours of community service.
cording to the indictment, on January
15, 2000, Johnson, without authori-
zation, cashed and kept for himself
the proceeds of a New Jersey Manu-
facturers Insurance Company settle-
ment check in the amount of $2,173
by forging the endorsement signa-
ture of Sean Caposella, Vice-Presi-
dent of Jefferson Loan Company.
The settlement check was issued by
New Jersey Manufacturers and




                                                                                                                         99
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 denied the claim and referred the case   store receipt to a Morris Township po-
                 to OIFP. On May 2, 2003, Mangiola        lice officer in support of his claim that
                 was sentenced to two years probation     the television was stolen. Parsam
                 conditioned upon paying $1,278 in        subsequently submitted an insurance
                 restitution to the insurance company.    claim to Liberty Mutual Insurance
                 He was also ordered to pay a $10,000     Company with the intent to defraud
                 civil insurance fraud fine.              the insurance company into replacing
                                                          the television and repairing damage to
                 State v.                                 his vehicle allegedly sustained in the
                 Zurab Tandilashvili                      attempted theft. On May 30, 2003,
                       On November 21, 2003, Zurab        Parsam was admitted into the PTI
                 Tandilashvili pled guilty to an Accu-    Program conditioned upon completing
                 sation charging him with forgery.        50 hours of community service and
                 Tandilashvili admitted that, on No-      paying a $1,500 civil insurance
                 vember 1, 2001, he submitted false       fraud fine.
                 garage rental and car rental receipts
                 totaling $3,450 in support of an auto-   State v.
                 mobile insurance liability claim to      Michael Marchevsky
                 Allstate Insurance Company. The in-          On October 22, 2003, Michael
                 surance claim related to an automo-      Marchevsky was admitted into the
                 bile accident which occurred on Au-      PTI Program conditioned upon per-
                 gust 14, 2001, in New York City in       forming 100 hours of community ser-
                 which Tandilashvili’s vehicle was        vice and paying a $2,500 civil insur-
                 struck by an Allstate insured vehicle.   ance fraud fine after he pled guilty to
                 On November 21, 2003, Tandilashvili      an Accusation charging him with at-
                 was admitted into the PTI Program        tempted theft by deception. In July of
                 conditioned upon performing 50 hours     2002, Marchevsky’s 2000 Ford F150
                 of community service and paying a        pick-up truck was burglarized and a
                 civil insurance fraud fine in the        window shattered. Marchevsky
                 amount of $5,000.                        claimed that several items valued at
                                                          over $4,000, including speakers and
                 State v.
                                                          a laptop computer, had been stolen
                 Pretam R. Parsam                         from his truck. Marchevsky subse-
                     On April 17, 2003, Pretam            quently filed a loss of property insur-
                 Parsam pled guilty to an Accusation      ance claim with Selective Insurance
                 charging him with attempted theft by     Company of America in the approxi-
                 deception. Parsam admitted that, on      mate amount of $4,980. Marchevsky
                 June 24, 2002, he falsely reported       admitted that he submitted a phony
                 the attempted theft of his 1993          receipt from AVIV Electronics in sup-
                 Honda Accord to the Morris Town-         port of his claim and that, in fact, he
                 ship Police Department. Parsam           had not suffered the loss as claimed.
                 also admitted that, on July 17, 2002,
                 he falsely reported to the Morris
                 Township Police Department that a
                 Sony television-stereo combo valued
                 at $1,244 had been stolen at the
                 time of the attempted theft of his au-
                 tomobile. Parsam presented a phony




100
Personal Injury                         and operated Best Buys Auto Parts         fraudulent auto theft insurance claim
Claims Adjuster Fraud                   and Cars in Cedar Grove. Some of the      with First Trenton Indemnity Insurance
                                        stolen cars were dismantled and the       Company which paid $31,518. On
                                        parts sold. False insurance claims        May 19, 2003, VonSee pled guilty to
State v.                                were submitted with respect to some       the charges and was admitted into
Joseph DeGregorio                       of the stolen cars. Among the stolen      the PTI Program conditioned upon
     A State Grand Jury returned an     vehicles supplied by Robinson were a      completing 75 hours of community
indictment in 2001 charging Joseph      1992 Ford valued at approximately         service and paying $27,669 in restitu-
DeGregorio with theft by unlawful       $10,000, a 1995 Dodge valued at ap-       tion to First Trenton Indemnity. On
taking. The indictment alleged that     proximately $14,425, a 1995 Honda         June 9, 2003, Levine pled guilty to
DeGregorio, who worked as an ad-        valued at approximately $13,775, a        conspiracy and was admitted into the
juster/paralegal for personal injury    1990 Mazda valued at approximately        PTI Program conditioned upon com-
lawyers, misappropriated approxi-       $6,500, a 1990 Toyota valued at ap-       pleting 75 hours of community ser-
mately $87,000 in insurance claim       proximately $9,725, a 1991 Toyota         vice.
settlement checks from various          valued at approximately $7,825, a
claimants who were clients of the law   1994 Toyota valued at $15,750, a          State v.
firm that employed him. The settle-     1995 Toyota valued at approxi-            Artan Rosania
ment checks were deposited into         mately $22,725, and a 1997                     On January 31, 2003, Artan
DeGregorio’s bank account which         Volkswagen valued at approxi-             Rosania was sentenced to three
was in the name of JRD Adjusting, a     mately $18,000. Holgate pled guilty       years in State prison following his
corporation he created. Following in-   to receiving stolen property and, on      guilty plea to receiving stolen prop-
dictment, DeGregorio fled to Florida    October 31, 2003, was sentenced to        erty. The charges related to the fact
where investigators from OIFP ar-       four years probation conditioned          that Rosania, as a salesman for
rested him. DeGregorio pled guilty to   upon serving 275 days in county           Newton Motor Sports, sold car keys
theft by deception and, on Septem-      jail. Holgate’s restitution will be de-   for luxury automobiles to under-
ber 19, 2003, he was sentenced to       termined by the Court.                    cover State Investigators so the
four years in State prison and or-            Robinson pled guilty to con-        cars could be stolen. OIFP investi-
dered to pay restitution in the         spiracy and receiving stolen property     gators along with Organized Crime
amount of $102,000.                     and on October 31, 2003, was sen-         and Racketeering Bureau investiga-
                                        tenced to five years probation condi-     tors in the Division of Criminal Jus-
Receiving                               tioned upon serving 364 days in           tice investigated the case.
Stolen Property                         county jail. Robinson was also or-        State v.
                                        dered to pay $24,000 in restitution.
State v.                                      The indictment charging Levine
                                        and VonSee alleged that, between
Thomas Robinson, David Levine
                                        August 11, 1998 and October 14,
and Robert VonSee
                                        1998, VonSee “gave up” his 1990
     On April 1, 2003, Thomas
                                        Mercedes Benz to Levine who then
Robinson was charged by a Passaic
                                        provided the vehicle to Holgate.
County Grand Jury with conspiracy
                                        Levine assisted VonSee in falsely re-
and receiving stolen property. Also
                                        porting his 1990 Mercedes stolen.
named in a separate but related in-
                                        Levine also allegedly falsely reported
dictment were David Levine and
                                        the Mercedes stolen to the Wayne
Robert VonSee, who were charged
                                        Police Department. VonSee filed a
with conspiracy and theft by decep-
tion. The indictment against
Robinson alleged that, between
June of 1997 and January of 1999,
Robinson provided stolen cars to
Frank Thomas Holgate who owned




                                                                                                                       101
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Andrzej Domanski                        Fictitious Accidents
                       On June 12, 2003, Andrzej
                 Domanski pled guilty to an Accusa-      State v.
                 tion charging him with receiving sto-   Anhuar Bandy,
                 len property. Domanski admitted
                                                         Alejandro Ventura, Elvin Castillo,
                 that, on February 20, 2003, he took
                                                         Raynaldo Cuevas, Cesar Caba,
                 possession of a 2001 BMW X5 auto-
                 mobile for compensation, knowing        Victor Almonte, et al.
                 the car had been falsely reported            The prosecution of this large-
                 stolen in East Orange two days ear-     scale staged accident ring ad-
                 lier. On July 18, 2003, Domanski        vanced significantly in 2003.
                 was sentenced to two years proba-       Twenty-eight persons were named
                 tion, receiving credit for two days     in ten separate State Grand Jury in-
                 served in county jail.                  dictments in 2002 charging them
                                                         variously with racketeering, con-
                 State v.                                spiracy, health care claims fraud, at-
                 M. M.                                   tempted theft and theft by decep-
                      On October 2, 2003, OIFP inves-    tion, use of a 17 year old or younger
                 tigators executed a search warrant      to commit a criminal offense, and
                 and arrested a suspect known in the     possession of a weapon without a
                 investigation as M.M. Numerous cars     permit. All of the charges relate to
                 and car parts were seized during the    allegations that the defendants par-
                 search, suggestive of the operation     ticipated in phony automobile acci-
                 of a “chop shop” and probable auto-     dents in and around Union County
                 mobile insurance fraud. M.M. was        to submit false insurance claims.
                 charged with receiving stolen prop-          The main indictment in this case
                 erty, dealing in stolen property, and   charged racketeering and related
                 certain alterations of motor vehicle    crimes, alleging that Anhuar Bandy,
                 identification numbers. Bail was set    who owned, controlled, or operated
                 at $50,000 with a 10% cash option.      as the chief corporate officer of six
                 The identity of M.M. has not been re-   North Jersey chiropractic clinics, and
                 leased to preserve the integrity of     Alejandro Ventura, Elvin Castillo,
                 OIFP’s ongoing investigation.           Raynaldo Cuevas, Cesar Caba and
                                                         Victor Almonte, all of whom were as-
                                                         sociated with Anhuar Bandy or the
                 Staged and                              clinics, allegedly fabricated eight
                                                         phony automobile accidents. It also
                                                         alleged that, as a result of these
                                                         eight phony automobile accidents,
                                                         claimants submitted PIP insurance
                                                         claims in excess of $331,000 to sev-
                                                         eral insurance companies. Addition-
                                                         ally, the indictment alleged that in-
                                                         surance claims in excess of $2 mil-
                                                         lion were also submitted in conjunc-
                                                         tion with more than 90 other phony
                                                         accidents. According to the indict-
                                                         ment, the accidents were con-
                                                         structed by obtaining cars, soliciting
                                                         drivers and passengers, faking acci-




102
dents, and then sending the occu-         pany, Bayside Casualty, Clarendon          Jones, and Rashonda Harris, all of
pants of the cars to treat at chiro-      National, Continental Insurance,           whom claimed to have sustained inju-
practic clinics in order to submit the    Farm Family Insurance Company,             ries requiring medical treatment. PIP
fraudulent insurance PIP claims. As       Liberty Mutual Insurance Company,          insurance claims of approximately
part of the conspiracy to construct       Maryland Insurance Company, the            $47,700 were submitted to Keystone
phony accidents, the State alleged        Moxon Company, National Conti-             Insurance Company/AAA Mid-Atlantic
that Ventura, Castillo, Cuevas, Caba,     nental Progressive, National Gen-          Insurance Company under Holly’s au-
and Almonte acted as “runners” and        eral Insurance Company, N.J. Cure,         tomobile insurance policy for this pur-
recruited persons to participate in the   Ohio Casualty Insurance Company,           ported accident. The State further al-
phony automobile accidents. The           Parkway Insurance, Progressive             leges that the second phony accident
State also alleged that the persons       Casualty, Red Oak Insurance Com-           planned by Campbell took place on
who participated in the phony acci-       pany, United States Automobile As-         September 16, 1998 in Newark involv-
dents became patients at several of       sociation (USAA), and New Jersey           ing co-defendants Robert Paul
the Bandy owned, controlled, or op-       Manufacturers Insurance Company.           Mitchner
erated chiropractic clinics, as well as        During calendar year 2003, three      a/k/a “Shaboor,” Chad Watson,
at other medical service provider of-     of the six indicted racketeers pled        Ramil Robinson, Duane Smith,
fices, even though they were not hurt     guilty to conspiracy to commit rack-       Monesha Gray, and Deborah Mathis
in the phony accidents. The indict-       eteering and face prison sentences.        and that they also submitted phony
ment also alleged that the “runners”      Another defendant also pled guilty to      PIP insurance claims to Keystone In-
were sometimes known as “con-             health care claims fraud and faces a       surance Company/AAA Mid-Atlantic
structors” because they allegedly         prison sentence. To date, approxi-         Insurance Company totaling approxi-
constructed these automobile acci-        mately 24 of the 28 indicted defen-        mately $42,950. In both cases, Key-
dents. The other indictments              dants charged with participating in        stone Insurance Company/AAA Mid-
charged the remaining 22 defen-           the ring have pled guilty.                 Atlantic Insurance Company became
dants for their participation in the                                                 suspicious of the claims, denied pay-
eight phony accidents as passen-          State v.                                   ment, and referred the matters to
gers, drivers and/or claimants.           Dannie Campbell, et al.                    OIFP. On October 24, 2003,
These 22 defendants were named                 On March 19, 2003, a State            Campbell failed to appear in Court
based on their participation as pas-      Grand Jury returned three indict-          and a bench warrant was issued for
sengers, vehicle operators, and in-       ments charging Dannie Campbell             his arrest. The cases as to the
surance claimants treating at various     and ten other defendants with con-         other defendants are pending trial.
chiropractic clinics in order to submit   spiracy, health care claims fraud,         State v.
insurance claims as part of the con-      and attempted theft by deception.          Ali Harvey, Roy Bailey
spiracies involving these phony auto-     According to the indictments, be-
mobile accidents. The State further       tween July of 1997 and March of
alleged that most of the claim money      1999, Dannie Campbell master-
was paid to Bandy owned, operated,        minded two fictitious automobile ac-
or controlled chiropractic clinics. The   cidents involving other co-conspira-
victimized insurance companies in-        tors in order to have the co-conspira-
cluded Allstate Insurance Company,        tors treat for injuries purportedly sus-
Kemper Insurance Company, MDA/            tained in the phony accidents and
Newark Insurance Company, Pru-            submit Personal Injury Protection
dential Insurance Company, Repub-         (PIP) insurance claims to an insur-
lic Western Insurance Company (U-         ance company. The State alleges
Haul of Arizona), Selective Insurance     that the first phony automobile acci-
Company, Sentry Insurance Com-            dent planned by Campbell took
pany, State Farm Insurance Com-           place on July 24, 1997, in Hillside,
                                          involving co-defendants George Holly,
                                          Jr., Shaheen Johnson, Nathaniel




                                                                                                                           103
              OIFP Criminal Case Descriptions –
              Insurance Fraud


 and Irene Smith                              On March 7, 2003, Rene Obredor        guilty to charges arising out of this il-
      An Essex County Grand Jury         was sentenced to one year probation        licit scheme. In November of 2002,
 handed up an indictment in 2002         conditioned upon completing 50 hours       Lareen Blakney-Reed was sen-
 charging Roy Bailey and Irene Smith     of community service and paying a          tenced to 18 months probation and
 with conspiracy to commit theft by      $750 criminal fine. Obredor had pled       ordered to pay $12,041 in restitution,
 deception and attempted theft by de-    guilty to an Accusation charging him       while Danielle Miller was sentenced
 ception. According to the indictment,   with attempted theft by deception, ad-     to one year probation and ordered to
 on February 11, 1997, Ali Harvey,       mitting that he caused a purported         pay $9,143 in restitution. On Decem-
 Bailey, and Smith reported to the       Glenwood Police Department automo-         ber 13, 2002, Loreen Blakney was
 Newark Police Department that they      bile accident report to be falsified so    sentenced to three years probation
 were passengers in an automobile        as to reflect that, on or about February   and ordered to pay $15,916 in resti-
 which was struck by another vehicle     11, 1999, he was injured in an auto-       tution. On January 31, 2003, Yvonne
 that had run a stop sign and fled.      mobile accident. Obredor also admit-       Blakney was sentenced to two years
 The indictment alleged the accident     ted that he used the false police acci-    probation conditioned on paying
 never occurred and that they treated    dent report to support an automobile       $10,634 in restitution to General Ac-
 at an East Orange chiropractic clinic   insurance PIP claim which was sub-         cident Insurance Company and serv-
 for injuries they falsely claimed to    mitted to First Trenton Indemnity In-      ing 100 hours of community service.
 have sustained in the phony accident    surance Company and New Jersey
 so that bodily injury and PIP claims    Manufacturers Insurance Company,           State v.
 could be submitted to State Farm In-    along with several other falsified claim   Robin Ellison, et al.
 surance Company. State Farm de-         documents. At his guilty plea hearing,          A Burlington County Grand Jury
 nied the claims and referred the case   Obredor admitted that he sought            returned an indictment in 2002
 to OIFP for investigation. Harvey       medical treatments for purported in-       charging Robin Ellison, Denise
 pled guilty to an Accusation charging   juries arising from the accident, even     Gaines, Patricia Oglesby, and
 him with conspiracy. He was admit-      though he was not really injured in        Deborah Thomas with conspiracy,
 ted into the PTI Program and or-        an automobile accident as he had           health care claims fraud, and theft
 dered to complete 50 hours of com-      claimed to the insurance companies.        by deception. According to the in-
 munity service. On November 22,         The insurance companies denied             dictment, on April 10, 1998,
 2002, Bailey was arrested pursuant      fraudulent PIP claims of approxi-          Gaines, Oglesby and Thomas were
 to a bench warrant issued for unre-     mately $5,000 and referred the case        passengers in a vehicle being
 lated charges and arraigned in          for investigation.                         driven by Ellison in Philadelphia,
 Essex County Superior Court. He                                                    Pennsylvania, when they conspired
 later failed to appear for a court      State v.
                                                                                    to falsely claim that an automobile
 hearing and a second bench warrant      Yvonne Blakney, et al.                     accident had occurred. Ellison re-
 was issued for his arrest. Smith pled        Loreen Blakney falsely reported       ported the collision to the Philadel-
 guilty to the charges in the indict-    to the Camden Police Department            phia Police Department and all four
 ment and was sentenced on March         on August 9, 1997, that her vehicle        defendants told the responding of-
 7, 2003, to two years probation con-    was struck by an unidentified hit-         ficer that they were injured in the
 ditioned upon completing 100 hours      and-run driver while she was driving.      phony accident. Ellison also re-
 of community service.                   She also claimed that Lareen               ported to State Farm Insurance
 State v.                                Blakney-Reed, Loreen’s twin sister;        Company that her vehicle was in-
 Rene Obredor                            Yvonne Blakney, Lareen’s daughter;         volved in a motor vehicle accident.
                                         and Danielle Miller, a friend, were             The indictment alleged that all
                                         passengers in the vehicle. Following       four defendants subsequently sub-
                                         the falsely reported accident, they re-    mitted fraudulent PIP claims to State
                                         ceived treatment from medical ser-         Farm for reimbursement for health
                                         vice providers, causing General Ac-        care services for injuries they claimed
                                         cident Insurance Company to pay            to have sustained.          Oglesby,
                                         PIP medical payments totaling over         Gaines, and Thomas pled guilty to
                                         $47,000. All four defendants pled




104
one count each of theft by deception.      John Groff, et al.
On January 10, 2003, Oglesby was                A State Grand Jury returned an
sentenced to five years probation con-     indictment charging John Groff, Luis
ditioned upon serving 180 days in          Ruiz and 27 others with conspiracy
county jail, payment of $2,011 in resti-   and attempted theft by deception in
tution to State Farm and payment of a      July of 2001. Groff and Ruiz, who es-
$2,500 civil insurance fraud fine.         sentially acted as “runners,” conspired
Gaines was also sentenced on Janu-
ary 10, 2003 to three years probation
conditioned upon serving 180 days in
county jail, payment of $7,560 in resti-
tution to State Farm, and payment of
a $2,500 civil insurance fraud fine. On
January 17, 2003, Thomas was sen-
tenced to five years probation condi-
tioned upon serving 180 days in
county jail, paying restitution in the
amount of $7,560 to State Farm, and
paying a $2,500 civil insurance fraud
fine. Ellison pled guilty to conspiracy
and health care claims fraud and on
January 17, 2003, she was sen-
tenced to three years in State prison,     with 27 other defendants to stage a to-
payment of $16,741 in restitution to       tal of seven automobile accidents in
State Farm, and a $5,000 civil insur-      and around Camden County. As a re-
ance fraud fine. On August 4, 2003,        sult of these phony accidents, phony
Pauline Whitfield pled guilty to an        PIP claims totaling nearly $97,000
Accusation charging her with health        were submitted to five insurance carri-
care claims fraud and imperson-            ers, including Allstate Insurance Com-
ation, admitting that she also             pany, State Farm Insurance Company,
fraudulently claimed to have been          Liberty Mutual Insurance Company,
injured in the same automobile acci-       Prudential Insurance Company, and
dent as the other four defendants. In      Material Damage Adjustment Corpora-
particular, she admitted that she          tion. False police reports were made to
had misrepresented herself to be           six police departments, including
Paulette Jones to the investigating        Pennsauken, Voorhees, Cherry Hill,
officer and to State Farm Insurance        Bellmawr, Camden, and Gloucester
Company for the purpose of submit-         Township. Due to the suspicious na-
ting fraudulent health insurance           ture of the claims, the carriers re-
claims in the amount of $16,908, of        fused payment and referred the case
which State Farm paid approxi-             to OIFP for further investigation. Ruiz
mately $5,900. On December 19,             pled guilty to conspiracy to commit
2003, Whitfield was sentenced to           theft by deception in January of 2002
five years probation conditioned           and was sentenced to three years in
upon serving 364 days in county            State prison with one year of parole
jail, ordered to pay $5,913 in restitu-    ineligibility. He was also ordered to pay
tion to State Farm, and to pay a           a $20,000 civil insurance fraud fine.
$5,000 civil insurance fraud fine.         Groff pled guilty to attempted theft by
                                           deception, admitting that he conspired
State v.                                   with the 28 other defendants to “stage”




                                                                                       105
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 the phony accidents. On September         to be sentenced in early 2004. Seven
                 19, 2003, he was sentenced to seven       of the co-conspirators had been previ-
                 years in State prison with three and a    ously charged by OIFP in three sepa-
                 half years of parole ineligibility. The   rate indictments returned, respec-
                 other defendants were admitted into       tively, by the Essex County Grand
                 the PTI Program conditioned upon          Jury on May 9, 2003, and by the
                 paying a $1,000 civil insurance fraud     Union County Grand Jury on April 9,
                 fine and continued cooperation with       2003. An eighth co-conspirator had
                 the State.                                been previously charged by a State
                                                           Grand Jury.
                 State v.
                 Neil Arruda                               State v.
                 and Simone Fernandes                      Rui Salgado, Anthony Padovano,
                      On August 29, 2003, a State          Ricardo Ventura
                 Grand Jury returned two separate in-      and Joseph Caponegro
                 dictments against Neil Arruda and              In another case stemming from
                 his girlfriend, Simone Fernandes,         the M&A Auto Body investigation, a
                 arising out of an OIFP investigation      Union County Grand Jury returned
                 of M&A Auto Body. The first indict-       an indictment charging Rui Salgado,
                 ment charged Arruda with con-             Anthony Padovano, Ricardo
                 spiracy, theft by deception, and false    Ventura, and Joseph Caponegro
                 incrimination. Fernandes was              with conspiracy and theft by decep-
                 charged in the second indictment          tion. According to the indictment, on
                 with conspiracy, theft by deception,      October 22, 1999, Padovano inten-
                 and hindering apprehension or pros-       tionally drove his 1998 Toyota into a
                 ecution. The indictments alleged          1998 Ducati motorcycle and a 1999
                 that, between March of 1998 and           Kawasaki Ninja motorcycle, both of
                 February of 2000, Arruda orches-          which were parked without riders in
                 trated five staged accidents with the     front of Caponegro’s house. The
                 help of nine co-conspirators, includ-     State alleged that Padovano falsely
                 ing Fernandes, which generated            reported to the Union Township Po-
                 over $80,000 in fraudulent automobile     lice Department that the collision
                 insurance claims submitted to various     was an accident so that he could
                 insurance companies. On November          submit false insurance claims. The
                 21, 2003, Fernandes pled guilty to        indictment also alleged that
                 theft by deception. She is scheduled      Padovano, Caponegro, Salgado,
                                                           and Ventura conspired to stage the
                                                           purported accident and shared in the
                                                           proceeds of the insurance claims
                                                           monies paid by Rider Insurance
                                                           Company, Elco Administrative Ser-
                                                           vices, and Prudential Insurance
                                                           Company in the amount of $13,334.
                                                           Ventura pled guilty to theft by decep-
                                                           tion and, on October 3, 2003, was
                                                           sentenced to three years probation
                                                           conditioned upon serving 180 days in
                                                           county jail and ordered to pay a $500
                                                           criminal fine. Padovano and




106
Caponegro were acquitted by a jury        $1,000. Pursuant to the plea agree-        health care claims fraud, and at-
following a trial in Union County. On     ment, as to Oliviera, the second in-       tempted theft by deception. The in-
October 14, 2003, Salgado pled            dictment was dismissed at sentenc-         dictments alleged that one of the
guilty to an amended charge of hin-       ing. Antunes pled guilty to unsworn        conspirators, Eric Boyer, master-
dering apprehension or prosecution        falsification to authorities, and on De-   minded three staged accidents in-
and was sentenced to one year pro-        cember 12, 2003, was sentenced to          volving 21 other co-conspirators
bation conditioned upon paying a          two years probation and payment of a       which resulted in the submission of
$750 criminal fine.                       $500 criminal fine. On October 20,         multiple phony PIP insurance claims
                                          2003, da Cruz pled guilty to the           to several insurance companies. The
State v.                                  amended charge of making a false re-       indictments alleged that, between
Antonio Oliviera,                         port to law enforcement authorities        October of 1998 and October of
Francisco da Cruz,                        and was sentenced to probation and         1999, Boyer planned and orches-
Maria Antunes                             payment of a $500 fine.                    trated the three fictitious automobile
and Nelson Soares                              A State Grand Jury returned an-       accidents with 21 other defendants
     As part of the M&A Auto Body in-     other indictment, also stemming from       who posed as passengers in the ac-
vestigation, Antonio Oliviera, Fran-      the M&A investigation, charging            cidents. According to the indict-
cisco da Cruz, and Maria Antunes          Nelson Soares with conspiracy, theft       ments, these three fictitious acci-
were variously charged in two sepa-       by deception, and hindering appre-         dents resulted in the submission of
rate Essex County indictments with        hension. This indictment alleged           over $204,378 in fraudulent PIP in-
conspiracy, theft by deception, and       that, on August 21, 1998, Soares           surance claims to Progressive Insur-
unsworn falsification to authorities.     and several others rented a U-Haul         ance Company, State Farm Insur-
The first of the two indictments al-      truck to purposely cause an accident       ance Company, and Alamo-National
leged that, between March 11, 1998        to generate a phony insurance claim.       Union Fire Insurance Company.
and October 26, 1998, Oliviera and        According to the indictments, Soares       One of the indictments alleged that
da Cruz conspired to obtain a 1999        then drove the U-Haul truck into a         Boyer orchestrated a staged acci-
Isuzu Rodeo from a body shop in           1994 BMW and allegedly falsely re-         dent which purportedly occurred on
Newark, and intentionally drove it        ported to the Newark Police Depart-        October 5, 1998, in East Orange.
into a 1993 Nissan in Newark so that      ment that an automobile accident           The indictment alleged that Boyer
property damage insurance claims          had occurred. Soares is currently a        recruited Shaquan McLaurin, Kirk
could be submitted to Liberty Mutual      fugitive and his case is pending trial.    McNeil, Alnicsa Franklin, Otis Chris-
Insurance Company. In total, ap-          State v.                                   topher, Rodney Mayes, and
proximately $18,263 in property           Eric Boyer, et al.                         Raynelle Hamilton to claim that, on
damage was paid on this alleged                On May 19, 2003, 22 individuals       October 5, 1998, they were passen-
fraudulent insurance claim. The sec-      were named in four State Grand Jury        gers in a van driven by Boyer and
ond indictment alleged that, between      indictments charging conspiracy,           that they were supposedly injured in
October 6, 1998 and January 19,                                                      an accident which, in fact, never oc-
1999, Oliviera and Antunes staged                                                    curred. The indictment alleged that
an accident involving a 1994 Honda                                                   these defendants were treated for
Civic. The indictment further alleged                                                their purported injuries and approxi-
that Antunes reported the accident to                                                mately $66,052 in PIP insurance
the Newark Police Department and                                                     claims were submitted to Progres-
submitted a false automobile acci-                                                   sive as a result. Progressive denied
dent report to Liberty Mutual Insur-                                                 the claims.
ance Company claiming property                                                            According to another one of the
damage in the amount of $8,195.                                                      indictments, Boyer orchestrated a
Oliviera pled guilty to theft by decep-                                              staged accident on November 1,
tion, and on December 12, 2003, was                                                  1998, in West Orange in which a
sentenced to two years probation and                                                 van allegedly driven by Tamika
ordered to pay a criminal fine of




                                                                                                                          107
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Sutton collided with a vehicle driven
                 by Valentino White. It is alleged that    State v.
                 the passengers in the van were            Iris Salkauski, et al.
                 Sakinah Hill, Shinaka Hill, Louis              On January 13, 2003, a State
                 McKenzie, Kevin Douglas, and              Grand Jury returned ten separate in-
                 Emilio Mayes, and the passengers          dictments charging 48 persons with
                 in White’s vehicle were Vanessa           conspiracy, theft by deception, and
                 Miller, Raphael McCray, and an-           attempted theft by deception for their
                 other person who was not identified       alleged participation in a staged ac-
                 in the indictment. It is also alleged     cident ring. The indictments alleged
                 that the occupants of both vehicles       that the 48 defendants planned or
                 were treated for purported injuries       participated in at least ten “staged”
                 sustained in the staged accident          automobile accidents over a two and
                 and subsequently submitted PIP in-        one half year period from December
                 surance claims to Progressive and         9, 1996 through May 27, 1998, in the
                 State Farm. The PIP insurance             Camden County area. As a result of
                 claims submitted to both carriers to-     the “staged” accident scheme,
                 taled approximately $62,865, of           Allstate Insurance Company re-
                 which the carriers paid $5,389.           ceived PIP claims totaling $567,940.
                       Another one of the indictments           The OIFP investigation deter-
                 alleged that Boyer arranged a staged      mined that the defendants would al-
                 accident which occurred on Decem-         legedly “stage” fake automobile acci-
                 ber 1, 1998, in Irvington. According      dents by purposely crashing cars
                 to the indictment, Boyer arranged for     into one another or into fixed objects.
                 Tamika Sutton to report that she had      The motor vehicle accidents would
                 been driving a rented van which had       be reported to area police depart-
                 been struck by a hit and run vehicle.     ments, principally the Camden and
                 It is alleged that passengers in the      Pennsauken Police Departments, af-
                 van driven by Sutton were Sheri           ter which the “victims” would seek
                 Brown, Robert Henderson, Ona              and obtain treatment for purported
                 Jones, Ali Sawab, Shonique Carney,        injuries sustained as a result of the
                 and Sareesah Houston. As was al-          “staged” accidents. Ultimately,
                 leged in all of the other phony acci-     fraudulent PIP claims were filed with
                 dents, the indictment alleged that all    Allstate Insurance Company for pay-
                 of the occupants in the rented van        ment or reimbursement of medical
                 claimed they sustained injuries, were     expenses and “pain and suffering”
                 treated for the purported injuries, and   costs. At least one “staged” accident
                 submitted PIP insurance claims total-     involved undercover law enforce-
                 ing $75,460 to Alamo-National Union       ment officers posing as participants
                 Fire Insurance Company.                   in the illegal scheme.
                       On September 15, 2003, McNeil            The principal indictment identi-
                 pled guilty to attempted theft by de-     fied Iris Salkauski as the alleged
                 ception and is scheduled to be sen-       leader of the conspiracy and the co-
                 tenced early in 2004. On November         ordinator of each of the ten “staged”
                 10, 2003, McKenzie pled guilty to at-
                 tempted theft by deception and is also
                 scheduled to be sentenced early in
                 2004. All remaining defendants are
                 pending trial.




108
accidents. It alleged that Salkauski or-    surance fraud fine in the amount of       spiracy, simulating a motor vehicle
chestrated the “staged” accidents, re-      $235,000. Several other defendants        insurance card, and possession of
cruited the participants for each of the    pled guilty and received probationary     CDS. On February 14, 2003, Tho-
“staged” accidents, paid them for their     dispositions while the remaining de-      mas-Malik was sentenced to 364
participation in the “staged” accidents,    fendants are pending trial.               days in county jail as a condition of
and directed them to obtain medical                                                   three years probation.
care and legal services. Salkauski re-      Fictitious Insurance
mained a fugitive from the time of the                                                State v.
indictment until her arrest on March 5,
                                            Identification Cards                      Brett Denby
2003, when she was found cowering           and Motor Vehicle                              On January 8, 2003, a
in a bedroom closet inside a resi-          Documents                                 Cumberland County Grand Jury re-
dence in Kissimmee, Florida.                (Uninsured Motorists)                     turned an indictment charging Brett
Salkauski was lodged in the Osceola                                                   Denby with simulating a motor ve-
County Jail without bail until her extra-                                             hicle insurance identification card.
                                            State v.
dition to New Jersey.                                                                 The indictment alleged that, on
                                            Jenette Thomas-Malik, et al.
     Hector Bonilla, one of the partici-                                              June 7, 2002, Denby produced a
                                                 An Essex County Grand Jury re-
pants, pled guilty to conspiracy and,                                                 counterfeit motor vehicle insurance
                                            turned indictments against Jenette
on June 20, 2003, was sentenced to                                                    identification card, purportedly is-
                                            Thomas-Malik and Yolanda Daniels
four years in State prison to run con-                                                sued by Merchants Mutual Insur-
                                            a/k/a Yolanda Adams, charging them
current with a county jail sentence                                                   ance Company, to a person con-
                                            variously with conspiracy, theft by
stemming from an unrelated matter.                                                    ducting a routine inspection of
                                            deception, simulating a motor ve-
Restitution and civil insurance fraud                                                 Denby’s car at the Millville motor ve-
                                            hicle insurance identification card,
fines were also imposed. David                                                        hicle inspection facility. The indict-
                                            forgery, and possession of a con-
Gonzalez, another participant, pled                                                   ment also alleged that, on June 23,
                                            trolled dangerous substance (CDS).
guilty to conspiracy and, on Septem-                                                  2002, Denby displayed a purported
                                            The indictment alleged that Thomas-
ber 19, 2003 was sentenced to three                                                   Merchants Mutual counterfeit motor
                                            Malik, Daniels, and another con-
years probation conditioned upon                                                      vehicle insurance identification card
                                            spirator, Regina Bryan, fraudulently
performing 150 hours of community                                                     to a New Jersey State Trooper dur-
                                            sold fictitious “insurance” in the form
service and paying a $1,500 civil in-                                                 ing a traffic stop. Denby’s case is
                                            of phony insurance identification
surance fraud fine. Ileana Gonzalez,                                                  pending trial.
                                            cards and phony insurance policy
another participant, pled guilty to
                                            “declaration pages” to individuals, in-   State v.
conspiracy and, on September 19,
                                            cluding two undercover State Investi-
2003 was sentenced to two years                                                       John Galiazzi
                                            gators for $600. Kareem Young, a
probation conditioned upon perform-                                                        On January 31, 2003, John
                                            co-conspirator of Thomas-Malik,
ing 100 hours of community service.                                                   Galiazzi was sentenced to three
                                            Daniels, and Bryan, pled guilty to an
Miguel Roman and Elba Soto, two                                                       years probation and ordered to
                                            Accusation charging him with con-
other participants, pled guilty to con-                                               serve 120 days of community ser-
                                            spiracy and theft by deception for his
spiracy. On November 14, 2003, Ro-                                                    vice after he pled guilty to an Accu-
                                            role in the conspiracy. Young was
man was sentenced to three years                                                      sation charging him with simulating
                                            sentenced to 27 days in jail as a con-
probation conditioned upon perform-                                                   a motor vehicle insurance identifica-
                                            dition of three years probation, and
ing 150 hours of community service                                                    tion card. Galiazzi admitted that he
                                            ordered to seek, obtain, and main-
and ordered to pay a $1,500 civil in-                                                 produced and sold phony motor ve-
                                            tain employment. Regina Bryan pled
surance fraud fine. On November                                                       hicle insurance identification cards
                                            guilty to an Accusation charging her
14, 2003, Soto was sentenced to two                                                   purportedly issued by Selective In-
                                            with conspiracy to commit theft by
years probation conditioned upon
                                            deception and was sentenced to one
paying a $1,500 civil insurance fraud
                                            year probation conditioned upon
fine. Salkauski pled guilty to con-
                                            maintaining employment and con-
spiracy and on November 14, 2003,
                                            tinuing to attend drug rehabilitation.
was sentenced to five years in State
                                            Thomas-Malik pled guilty to con-
prison and ordered to pay a civil in-




                                                                                                                              109
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 surance Company of America and           Prison as the result of parole viola-
                 the Barclay Insurance Company. He        tions. On February 21, 2003, Casey
                 also admitted presenting a fictitious    was sentenced to six months in
                 motor vehicle insurance identifica-      State prison to run concurrently with
                 tion card to law enforcement au-         his parole violation prison sentence.
                 thorities during a traffic stop.
                                                          State v.
                 State v. T.R.                            Lamont Hines
                      As part of OIFP’s investigation         On January 27, 2003, Lamont
                 into the sale of fake motor vehicle      Hines pled guilty to an Accusation
                 documents, including fraudulently        charging him with conspiracy to sell
                 issued drivers’ licenses, T.R. pled      simulated motor vehicle insurance
                 guilty on May 5, 2003, to a one          identification cards. Hines admitted
                 count Essex County indictment            that following his earlier arrest on
                 which charged her with receiving         unrelated charges during a motor
                 stolen property. She admitted re-        vehicle stop in South Plainfield, he
                 ceiving a stolen 2000 Audi automo-       had in his possession 13 blank
                 bile. On the same date, she was ad-      State Farm Insurance Company au-
                 mitted into the PTI Program condi-       tomobile insurance identification
                 tioned upon completing 50 hours of       cards. Hines also admitted that he
                 community service.                       and another unidentified person
                                                          were selling the blank identification
                 State v.                                 cards out of Hines’s car. Hines was
                 Larry L. Casey                           sentenced on the same date to five
                       On February 21, 2003, Larry L.     years in State prison with 20 months
                 Casey pled guilty to an Accusation       parole ineligibility.
                 charging him with simulating a mo-
                 tor vehicle insurance identification     State v.
                 card. Casey admitted that, on May        Sonia Negron
                 4, 2002, he presented an altered              On February 20, 2003, a
                 automobile insurance identification      Camden County Grand Jury returned
                 card, purportedly issued by Pruden-      an indictment charging Sonia Negron
                 tial Insurance Company, to a Motor       with simulating a motor vehicle insur-
                 Vehicle Commission (MVC) inspec-         ance identification card. According to
                 tor while having his car inspected at    the indictment, on July 30, 2002, she
                 the Baker’s Basin inspection facility.   presented a phony automobile insur-
                 The Motor Vehicle Commission em-         ance identification card purportedly
                 ployee reported the matter to the        issued by Progressive Northern In-
                 State Police, who investigated the       surance Company to a New Jersey
                 case and referred it to OIFP for         State Trooper, knowing that the card
                 prosecution. On June 6, 1975,
                 Casey had previously been con-
                 victed of murder and served 24
                 years in State prison. He is currently
                 incarcerated at Bayside State




110
was a counterfeit and that she had no     she was asked for proof of insurance       mobile insurance identification card to
automobile insurance. On December         and presented the fictitious identifica-   a Franklin Township police officer. On
9, 2003, Negron was admitted into the     tion card. On March 10, 2003, Lasane       August 5, 2003, Membreno-Dominque
PTI Program conditioned upon per-         pled guilty and, on April 14, 2003, she    was admitted into the PTI Program
forming 50 hours of                       was admitted into the PTI Program          conditioned upon performing 50 hours
community service.                        conditioned upon completing 50 hours       of community service.
                                          of community service.
State v.                                                                             State v.
Gerry Frederique                          State v.                                   Jamel Laboo
     On April 14, 2003, Gerry             Zoila M. Collao-Villegas                        A Hudson County Grand Jury
Frederique was admitted into the PTI           A Union County Grand Jury re-         returned an indictment charging
Program conditioned upon complet-         turned an indictment charging Zoila        Jamel Laboo with simulating a mo-
ing 50 hours of community service         M. Collao-Villegas with simulating a       tor vehicle insurance identification
and participating in drug and alcohol     motor vehicle insurance identification     card. According to the indictment,
testing as directed by Probation.         card. According to the indictment,         while having his vehicle inspected
Frederique was charged by an              while having her vehicle inspected at      at the Jersey City Motor Vehicle
Essex County Grand Jury with simu-        the Plainfield Motor Vehicle Commis-       Commission inspection station,
lating a motor vehicle insurance          sion inspection facility, Collao-          Laboo presented a phony insurance
identification card. The indictment al-   Villegas presented a phony insur-          identification card, purportedly is-
leged that on August 2, 2001,             ance identification card, purportedly      sued by Allstate Insurance Com-
Frederique presented a phony motor        issued by Allstate Insurance Com-          pany, to the motor vehicle inspector.
vehicle insurance identification card     pany, to the motor vehicle inspector.      On July 29, 2003, Laboo was admit-
to an Irvington police officer, know-     On November 7, 2003, Collao-               ted into the PTI Program condi-
ing that the insurance identification     Villegas was admitted into the PTI         tioned upon performing 25 hours of
card, purportedly issued by the Colo-     Program conditioned upon perform-          community service.
nial Penn Insurance Company, was          ing 60 hours of community service.
a fake. Frederique allegedly pre-
sented the card to the Irvington po-      State v.
lice officer when the police officer      Luis A. Membreno-Dominque
questioned him about an illegally              A Somerset County Grand Jury
parked 1999 Honda Accord.                 returned an indictment charging Luis
                                          A. Membreno-Dominque with simu-
State v.                                  lating a motor vehicle insurance
Regina Lasane                             identification card. According to the
     Regina Lasane was charged by         indictment, while attempting to get
an Essex County Grand Jury with           his vehicle released from the
simulating a motor vehicle insurance      Franklin Township Police Depart-
identification card. Lasane presented     ment impound lot, Membreno-
a phony motor vehicle insurance           Dominque presented a phony auto-
identification card to an Irvington po-
lice officer, knowing that the insur-
ance identification card, purportedly
issued by the Allstate Insurance
Company, was counterfeit. Lasane
was trying to retrieve her impounded
1989 Honda from the Irvington Po-
lice Department impound yard when




                                                                                                                               111
              OIFP Criminal Case Descriptions –
              Insurance Fraud


 State v.                                ance Company, gave him the blank in-     State v.
 Janie A. Jenkins-Morrison               surance identification cards for the     Wanda Bryan
      A Mercer County Grand Jury re-     purpose of selling them. Hopson and           Wanda Bryan was charged by a
 turned an indictment charging Janie     Casimire each subsequently pled          Mercer County Grand Jury with
 Jenkins-Morrison with simulating a      guilty to conspiracy. On September       simulating a motor vehicle insurance
 motor vehicle insurance identifica-     12, 2003, Hopson was sentenced to        identification card. According to the
 tion card. According to the indict-     two years probation conditioned          indictment, during a traffic stop in
 ment, on May 22, 2002, Jenkins-         upon serving 364 days in county jail     Hamilton Township, Bryan presented
 Morrison created two phony motor        and ordered to pay a $750 criminal       a phony insurance identification
 vehicle insurance identification        fine and to perform 75 hours of com-     card, purportedly issued by State
 cards, purportedly issued by A Clas-    munity service. Casimire was sen-        Farm Indemnity Company, to a
 sic Plan, Inc., and bearing the name    tenced on the same date to one year      Hamilton Township police officer.
 of an acquaintance, Eudean              probation and ordered to pay a $500      Bryan was admitted into the PTI Pro-
 McMillan. One phony motor vehicle       criminal fine and to perform 75 hours    gram on June 3, 2003.
 insurance identification card pur-      of community service.
 ported to provide insurance cover-                                               State v.
 age for a 1985 Cadillac and the         State v.                                 Yvette R. Williams
 other for a 1987 Lynx. On July 28,      Keisha Lashaye-                                On September 24, 2003, a
 2003, Jenkins-Morrison pled guilty      Dashawna Brown                           Cumberland County Grand Jury
 to simulating a motor vehicle insur-         On April 7, 2003, Keisha            charged Yvette R. Williams with
 ance identification card and was ad-    Lashaye-Dashawna Brown pled              simulating a motor vehicle insurance
 mitted into the PTI Program condi-      guilty to an Accusation charging her     identification card. According to the
 tioned upon performing 25 hours of      with simulating a motor vehicle insur-   indictment, Williams presented a
 community service.                      ance identification card. Brown ad-      phony motor vehicle insurance iden-
                                         mitted that, while having her automo-    tification card, purportedly issued by
 State v.                                bile inspected at the Millville Motor    Liberty Mutual Insurance Company,
 Montez Hopson                           Vehicle Commission inspection sta-       to a Millville Motor Vehicle Commis-
 and Tracey Casimire                     tion, she presented a phony automo-      sion inspector, while having her ve-
      An Essex County Grand Jury re-     bile insurance identification card,      hicle inspected at the Millville inspec-
 turned an indictment charging           purportedly issued by Newark Insur-      tion station. On October 15, 2003,
 Montez Hopson and Tracey                ance Company, to the motor vehicle       Williams failed to appear at her pre-
 Casimire with conspiracy and simu-      inspector. In May of 2003, Brown         arraignment interview. A bench war-
 lating a motor vehicle insurance        was admitted into the PTI Program        rant was issued for her arrest. Will-
 identification card. According to the   conditioned upon performing 20           iams’ case is pending trial.
 indictment, on July 11, 2001, follow-   hours of community service.
 ing his involvement in a motor ve-                                               State v.
 hicle accident, Hopson was arrested                                              Jimmy Gurzkovic
 for operating an uninsured motor ve-                                                 An Essex County Grand Jury re-
 hicle while his driver’s license was                                             turned an indictment charging Jimmy
 under suspension. At the time of his                                             Gurzkovic with simulating a motor
 arrest, approximately 17 blank Lib-                                              vehicle insurance identification card.
 erty Mutual Insurance Company in-                                                According to the indictment, between
 surance identification cards were in                                             May 16 and May 21, 2001,
 his possession. Also according to the                                            Gurzkovic, who owned and operated
 indictment, Hopson’s girlfriend,                                                 F&G Auto Repair, sold two phony,
 Tracey Casimire, in her capacity as                                              blank automobile insurance identifi-
 an employee of Liberty Mutual Insur-                                             cation cards to an undercover State
                                                                                  Investigator. On April 8, 2003,
                                                                                  Gurzkovic pled guilty to the indict-




112
ment. On July 18, 2003, Gurzkovic         Shariff was sentenced to 18 months
was sentenced to two years proba-         probation and ordered to complete
tion conditioned upon paying a $500       her college courses.
criminal fine and continued coopera-
tion with the investigation.              State v.
                                          Lunic Adisson
State v.                                       On June 27, 2003, an Essex
Emiled R. Herrera                         County Grand Jury returned an in-
     On July 2, 2003, a Union County      dictment charging Lunic Adisson
Grand Jury returned an indictment         with two counts of simulating a motor
charging Emiled Herrera with simu-        vehicle insurance identification card.
lating a motor vehicle insurance          According to the indictment, Adisson
identification card. According to the     presented the fictitious insurance
indictment, while having his 1995         identification card to an Irvington po-
Toyota pick-up truck inspected at a       lice officer to regain possession of
Plainfield Motor Vehicle Commission       her car, which had been impounded




facility, Herrera presented a phony au-   by the Irvington Police Department.
tomobile insurance identification         On July 29, 2003, Adisson was again
card, purportedly issued by New Jer-      indicted for her role in a health care
sey Manufacturers Insurance Com-          claims fraud scam involving Dr.
pany, to the motor vehicle inspector.     LeClerc Adisson. Lunic Adisson’s
Herrera’s case is pending trial.          cases are pending trial.

State v.
Tonya Shariff
a/k/a Sharif Bayyinah
     On May 16, 2003, Tonya Shariff
a/k/a Shariff Bayyinah pled guilty to
an Accusation charging her with
simulating a motor vehicle insurance
identification card. Shariff admitted
that she presented a phony automo-
bile insurance identification card,
purportedly issued by Security Insur-
ance Company, to a Jersey City Mo-
tor Vehicle Commission inspector
while having her vehicle inspected.




                                                                                    113
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 State v.                                 State v.
                 Paul J. Frye                             Juan G. Rivera
                      On July 29, 2003, Paul J. Frye           On August 8, 2003, Juan G.
                 pled guilty to an Accusation charg-      Rivera pled guilty to an Accusation
                 ing him with simulating a motor ve-      charging him with simulating a motor
                 hicle insurance identification card.     vehicle insurance identification card.
                 Frye admitted that he presented a        Rivera admitted that he presented a
                 phony automobile insurance identi-       phony insurance identification card,
                 fication card, purportedly issued by     purportedly issued by Palisades
                 IFA Insurance Company, to a Motor        Safety & Insurance Association, to
                 Vehicle Commission inspector at          an inspector at the Deptford Motor
                 the Millville inspection station,        Vehicle Commission inspection facil-
                 while having his vehicle inspected.      ity. On August 19, 2003, Rivera was
                 On the same date, Frye was admit-        admitted into the PTI Program, with
                 ted into the PTI Program condi-          the requirement that he provide
                 tioned upon performing 50 hours of       proof of valid automobile insurance.
                 community service.
                                                          State v.
                 State v.                                 Joel Jean-Pierre
                 Samuel Rodriguez                              On August 21, 2003, Joel Jean-
                      On July 29, 2003, a Cumberland      Pierre pled guilty to an Accusation
                 County Grand Jury returned an in-        charging him with forgery. Jean-
                 dictment charging Samuel Rodriguez       Pierre admitted that he altered a
                 with simulating a motor vehicle insur-   cancellation letter from his automo-
                 ance identification card. According to   bile insurance carrier, NJ Cure Insur-
                 the indictment, Rodriguez presented      ance Company, to falsely reflect that
                 a phony automobile insurance identi-     he had valid automobile insurance
                 fication card, purportedly issued by     coverage, and submitted the letter to
                 Allstate Insurance Company, to a         the New Jersey Motor Vehicle Com-
                 Motor Vehicle Commission inspector       mission in order to show proof of
                 at the Millville inspection station,     coverage. On the same date, Jean-
                 while having his vehicle inspected.      Pierre was admitted into the PTI Pro-
                 This case is pending trial.              gram conditioned upon performing
                                                          25 hours of community service.
                 State v.
                 Nimer Elsamna                            State v.
                     On August 20, 2003, an Essex         Tyshon Phipps
                 County Grand Jury returned an in-             On November 19, 2003, an
                 dictment charging Nimer Elsamna          Essex County Grand Jury returned
                 with forgery. According to the indict-   an indictment charging Tyshon
                 ment, Elsamna sold a fictitious Mo-      Phipps with simulating a motor ve-
                 tor Vehicle Commission temporary         hicle insurance identification card.
                 registration tag to an undercover        According to the indictment, on April
                 OIFP investigator. This case is
                 pending trial.




114
30, 2003, during the course of a traffic   Insurance Company, to an inspector        State v.
stop in Essex Fells, Phipps presented      at the Deptford Motor Vehicle Com-        Clarence E. Shambry, Sr.
the police officer with a fraudulent au-   mission inspection facility. On De-            On November 13, 2003, a
tomobile insurance identification card,    cember 5, 2003, Cacciavillano was         Camden County Grand Jury returned
purportedly issued by Progressive In-      admitted into the PTI Program.            an indictment charging Clarence E.
surance Company. This case is pend-                                                  Shambry, Sr., with simulating a mo-
ing trial.                                 State v.                                  tor vehicle insurance identification
                                           Alfred J. Whittaker                       card. The indictment alleged that, on
State v.                                        On November 13, 2003, Alfred         June 5, 2002, Shambry sold a ficti-
Jose Ramon Bouson                          Whittaker pled guilty to an Accusa-       tious motor vehicle insurance identi-
     On October 3, 2003, Jose              tion charging him with simulating a       fication card, purportedly issued by
Ramon Bouson pled guilty to an Ac-         motor vehicle insurance identification    Allstate Insurance Company, to a
cusation charging him with simulat-        card. Whittaker admitted that on          New Jersey State Trooper working in
ing a motor vehicle insurance identi-      February 25, 2003, following a motor      an undercover capacity, knowing
fication card. Bouson admitted that,       vehicle accident in Lawrence Town-        that the insurance identification card
on March 23, 2001, while on proba-         ship, he presented a false automo-        was counterfeit. Shambry’s case is
tion for an unrelated conviction, he       bile insurance identification card to a   pending trial.
manufactured and sold a counterfeit        Lawrence Township police officer.
motor vehicle insurance identification     On November 13, 2003, Whittaker           State v.
card to a person acting in an under-       was admitted into the PTI Program         John Solomon Riley
cover capacity for OIFP. Bouson            conditioned upon performing 50                 On November 10, 2003, John
awaits sentencing.                         hours of community service.               Solomon Riley pled guilty to an Ac-
                                                                                     cusation charging him with tamper-
State v.                                   State v.                                  ing with public records or informa-
Waddell A. Tidwell                         Marcy L. Moss                             tion. Riley admitted that, on May 11,
      On October 3, 2003, Waddell               On November 18, 2003, Marcy          2003, during a traffic stop in Morris
Tidwell pled guilty to an Accusation       Moss pled guilty to an Accusation         County, he presented a fraudulent
charging him with simulating a mo-         charging her with simulating a motor      driver’s license in the name of Mat-
tor vehicle insurance identification       vehicle insurance identification card.    thew Mercer to a Harding Township
card. Tidwell admitted that he sold        Moss admitted that on June 24,            police officer, knowing that the
fictitious insurance identification        2003, she produced and sold to an         driver’s license was a fake. On De-
cards to an undercover New Jersey          undercover New Jersey State               cember 22, 2003, Riley was sen-
State Trooper on three occasions.          Trooper, a false motor vehicle insur-     tenced to 18 months probation con-
Tidwell awaits sentencing.                 ance identification card, purportedly     ditioned upon serving 30 days in
                                           issued by Liberty Mutual Insurance        county jail.
State v.                                   Company, which purportedly re-
James Cacciavillano                        flected insurance coverage for a
    On October 16, 2003, James             1984 Pontiac in the name of David
Cacciavillano pled guilty to an Accu-      Reed. Moss admitted that she knew
sation charging him with simulating a      the insurance identification card was
motor vehicle insurance identification     counterfeit. Moss awaits sentencing.
card. Cacciavillano admitted that, on
October 10, 2002, he presented a
phony insurance identification card,
purportedly issued by Penn National




                                                                                                                             115
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 State v.                                 State v.
                 Jorge Luis Velasquez                     JoAnn Guzzi
                       On December 12, 2003, Jorge              On August 21, 2003, JoAnn
                 Luis Velasquez pled guilty to an Ac-     Guzzi pled guilty to an Accusation
                 cusation charging him with simulat-      charging her with official misconduct.
                 ing a motor vehicle insurance identi-    Guzzi admitted that, while an em-
                 fication card. Velasquez admitted        ployee of the Motor Vehicle Commis-
                 that on June 5, 2002, during a traffic   sion, on August 22, 2001, she manu-
                 stop in South Plainfield, he pre-        factured a duplicate automobile title
                 sented the police officer with a         application form in the name of Dian
                 fraudulent motor vehicle insurance       Douglas and signed Douglas’ name
                 identification card, purportedly is-     on the application without Douglas’
                 sued by the Liberty Mutual Insurance     knowledge or authorization. Guzzi
                 Company, knowing that the insur-         admitted that she sold the duplicate
                 ance identification card was counter-    title to Ismael Ramos for approxi-
                 feit. Velasquez awaits sentencing.       mately $80 knowing that Ramos was
                                                          not entitled to the duplicate automo-
                 State v.                                 bile title. Guzzi was terminated from
                 Boyd Robinson                            her employment with the Motor Ve-
                      A State Grand Jury returned an      hicle Commission on June 25, 2003.
                 indictment charging Boyd Robinson        The investigation is continuing and
                 with simulating a motor vehicle in-      further charges are possible. On
                 surance identification card, sale of a   September 26, 2003, Guzzi was sen-
                 simulated document, and forgery.         tenced to three years probation.
                 According to the indictment, be-
                 tween July of 2001 and August of         State v.
                 2001, Robinson sold a fictitious au-     Gina Guzzi
                 tomobile insurance identification             On September 15, 2003, Gina
                 card, purportedly issued by State        Guzzi pled guilty to an Accusation
                 Farm Indemnity Company, a ficti-         charging her with falsifying records.
                 tious New Jersey driver’s license,       Guzzi, who was an employee of the
                 and three fictitious motor vehicle in-   Vineland Motor Vehicle Commission
                 spection stickers to an undercover       office, admitted that on September
                 OIFP investigator. OIFP’s investiga-     27, 2000, she falsified and provided
                 tion into this matter began when it      to another woman a duplicate auto-
                 was contacted by the Irvington Po-       mobile driver’s license in the name
                 lice Department which had arrested       of a third woman by filling in the
                 a woman known as Snow Gossette           driver’s license application form as if
                 a/k/a Tykema Lewis, who had pre-         she (Guzzi) was the third woman,
                 sented a fictitious automobile insur-    without the third woman’s knowledge
                 ance identification card to an           or permission. Guzzi admitted that
                 Irvington police officer in order to     she provided the fraudulent driver’s
                 get her impounded vehicle re-            license knowing that it was false. On
                 leased. She identified Robinson as       October 24, 2003, Guzzi was sen-
                 the person who sold her the ficti-       tenced to three years probation and
                 tious identification card. On October    was permanently barred from public
                 17, 2003, Robinson pled guilty to        employment in New Jersey.
                 sale of a simulated document. He is
                 pending sentencing.




116
Health, Life,                             count to steal the money. Weinstein       probation conditioned upon paying
                                          failed to appear in court and a bench     restitution in the amount of $6,302
and Disability                            warrant was issued for his arrest on      and ordered to pay a civil insurance
Insurance Fraud                           February 25, 2003.                        fraud fine of $20,000.

                                          State v.                                  State v.
Health Care Provider Fraud                Arthur Dinkel                             Lev Natovich, Boris Natovich
                                               Arthur Dinkel, a former psy-         and Joseph Matriss
State v.                                  chologist who owned and operated               On July 10, 2003, Lev Natovich
Thomas Boselli                            two Paramus psychotherapy clinics,        was charged by a State Grand Jury
     Thomas Boselli pled guilty to an     pled guilty to an Accusation charg-       with health care claims fraud, con-
Accusation charging him with falsi-       ing him with theft by deception.          spiracy to commit health care claims
fying records. Boselli admitted that,     Dinkel admitted that, between Janu-       fraud, conspiracy to commit theft by
on January 24, 2001, he submitted         ary of 1998 and March of 1999, he         deception, unlawful practice of den-
a claim form to Horizon Blue Cross/       submitted fraudulent billings to vari-    tistry, theft by deception, and con-
Blue Shield for providing chiroprac-      ous insurance carriers. Dinkel’s          spiracy to commit unlawful practice
tic services as if he held a valid chi-   fraudulent billings took the form of      of dentistry. Also named in the indict-
ropractic physician’s license when,       overbilling for psychological ser-        ment was Boris Natovich, Lev
in fact, he did not. On January 3,        vices rendered, falsely billing the       Natovich’s father and the owner of
2003, Boselli was sentenced to two        health insurance policies of certain      United Dental Center. Boris Natovich
years probation conditioned upon          patients for psychological services       was charged with one count of con-
paying a $100,000 civil insurance         rendered to others who were not           spiracy to commit unlawful practice
fraud fine and completing 100 hours       covered, and billing for services pur-    of dentistry. The final defendant
of community service.                     portedly performed by a staff medi-       named in the indictment was Dr. Jo-
                                          cal doctor on dates prior to the          seph P. Matriss, a dentist licensed to
State v.                                  medical doctor’s employment and           practice dentistry in New Jersey, who
Martin Weinstein                          after his termination. In total, Dinkel   performed dental services at United
    Dr. Martin Weinstein was in-          was paid $45,281 by the various in-       Dental Center. Matriss was charged
dicted by a State Grand Jury and          surance companies for these               with health care claims fraud, con-
charged with health care claims           fraudulent billings. On April 4, 2003,    spiracy to commit health care claims
fraud, theft by deception and forgery.    Dinkel was sentenced to two years         fraud, conspiracy to commit theft by
The indictment alleged that, between      probation conditioned upon paying         deception, and theft by deception.
July of 1997 and January of 1999,         full restitution.                              The indictment alleged that, be-
Weinstein, a licensed podiatrist,                                                   tween September of 1999 and March
fraudulently billed Horizon Blue
                                          State v.                                  of 2002, Boris Natovich and Matriss
Cross/Blue Shield approximately           Roland Evans                              assisted Lev Natovich and another
$285,000 for podiatric services he             On March 11, 2003, Dr. Roland        person who was previously charged,
never rendered and for which he           Evans pled guilty to an Accusation        Vadim Lioubomoudrov, in providing
was paid more than $200,000.              charging him with health care claims      dental treatment to patients of United
Weinstein allegedly submitted the         fraud. Evans admitted that, between       Dental Center, including children,
fraudulent claims by means of elec-       January of 1996 and May of 2000,          even though neither Lev Natovich
tronic billing from his office to Hori-   he submitted fraudulent bills to Aetna    nor Lioubomoudrov were licensed to
zon Blue Cross/Blue Shield and di-        Life Insurance Company and Guard-         practice dentistry in New Jersey. It is
verted the insurance claim checks is-     ian/PHS Health Plans for chiropractic     also alleged that United Dental Cen-
sued to the patients to a Post Office     services he never rendered. Evans         ter submitted fraudulent bills for den-
box that he rented. It is alleged that    fraudulently billed Aetna and Guard-      tal services to Local 338 Fund, a la-
Weinstein would forge the patients’       ian a total of $12,313, for which he      bor union, and to Delta Dental Insur-
names on the back of the checks           was paid $6,302. On June 6, 2003,         ance for dental treatments per-
and deposit them into his own ac-         Evans was sentenced to three years        formed by persons who were not li-




                                                                                                                           117
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 censed dentists. The indictment fur-       Bergen County authorities pursuant
                 ther alleged that the fraudulent bills     to a bench warrant that had been is-
                 were submitted to the insurance car-       sued for his arrest on these charges.
                 riers claiming that Matriss, who was       On the same date, he pled guilty to
                 licensed, was the treating dentist,        theft by deception and was later sen-
                 even though he had not treated             tenced to two years probation and
                 some of the patients. This case is         ordered to pay restitution to the State
                 pending trial.                             Health Benefits Program in the
                                                            amount of $2,306, and a $2,500 civil
                 State v.                                   insurance fraud fine.
                 Vadim Lioubomoudrov
                      As part of the United Dental          State v.
                 Center investigation, on March 31,         Barry Vogel
                 2003, Vadim Lioubomoudrov, a na-                On June 12, 2003, a State
                 tive of Russia, pled guilty to an Accu-    Grand Jury returned an indictment
                 sation charging him with the unlawful      charging Barry M. Vogel, a former li-
                 practice of dentistry. Lioubomoudrov       censed neurologist, with health care
                 admitted that, between November of         claims fraud and theft by deception.
                 1997 and December of 1999, he pro-         According to the indictment, between
                 vided dental treatment to patients at      July of 1997 and May of 1999, Vogel
                 the United Dental Center located in        submitted fraudulent bills totaling
                 Wallington, even though he did not         more than $54,000 to Prudential
                 possess a license to practice den-         Property and Casualty Insurance
                 tistry in New Jersey. On May 9,            Company of New Jersey, for diag-
                 2003, Lioubomoudrov was admitted           nostic services he failed to render or
                 into the PTI Program conditioned           failed to render properly. It is alleged
                 upon continued cooperation with            that Vogel submitted fraudulent
                 OIFP’s investigation into the United       health insurance claims for electro-
                 Dental Center.                             diagnostic tests, known as nerve
                                                            conduction velocity (NCV) tests, per-
                 State v.                                   formed on patients who had alleg-
                 Jerome Cochran                             edly been injured in automobile acci-
                      Jerome Cochran was among ap-          dents. It is also alleged that he
                 proximately 200 defendants who             fraudulently submitted the same di-
                 were indicted or charged by way of         agnostic test results for multiple pa-
                 Accusation in a complex public cor-        tients. Vogel’s case is pending trial.
                 ruption health insurance fraud case
                 involving a licensed psychologist,
                 Carl Lichtman. Lichtman conspired
                 with employees of several New Jer-
                 sey school districts, including
                 Cochran, and submitted false health
                 insurance claims to more than 36 in-
                 surance carriers and health care
                 plans in order to steal millions of dol-
                 lars of health care insurance money.
                 Lichtman was previously sentenced
                 to State prison for his role in the con-
                 spiracy. On March 14, 2003, Jerome
                 Cochran voluntarily surrendered to




118
State v.                                    State v.                                   State v.
LeClerc Adisson                             Alan Ottenstein                            Alphonso Smith
and Lunic Adisson                                On July 16, 2003, OIFP investi-       and Daniel Catanzaro
      On July 29, 2003, a State Grand       gators executed a search warrant at             On December 17, 2003, a State
Jury returned an indictment against         the medical offices of Dr. Alan            Grand Jury returned an indictment
Dr. LeClerc Adisson, a licensed             Ottenstein located in Lawrenceville        charging Dr. Alphonso Smith and Dr.
medical doctor, and his niece, Lunic        and Hamilton Township, and a               Daniel Catanzaro with health care
Adisson, charging them with health          records storage facility located in        claims fraud, attempted theft by de-
care claims fraud, theft by deception,      Mount Holly. During the course of          ception, and theft by deception. The
misconduct by a corporate official,         executing the search warrant, sev-         indictment alleged that Smith, a li-
and falsifying records. According to        eral weapons, including a gun, am-         censed medical doctor, and
the indictment, between April of 1997       munition, a “stun gun” and other           Catanzaro, a licensed chiropractor,
and December of 2000, LeClerc               weapons, as well as marijuana were         operated a medical practice in
Adisson concealed the fact that he          found and seized. Ottenstein was           Wayne known as Quality Care Phy-
owned and had a “beneficial interest”       charged with possession of mari-           sicians. It is alleged that, between
in two corporations, Dantor Medical         juana with intent to distribute, pos-      July of 1997 and March of 1999, the
Supply and Clara Medical Services.          session with intent to distribute within   doctors submitted bills in the amount
It is further alleged that, with the as-    1,000 feet of a school, as well as         of $36,000 for anesthesia adminis-
sistance of his niece, Lunic Adisson,       with possession of prohibited weap-        tered by needle injection when, in
LeClerc Adisson, submitted bills to         ons and devices (explosives), pos-         fact, electrical stimulation therapy,
various insurance companies for             session of prohibited weapons and          which did not involve injected anes-
medical supplies and related ser-           devices (stun gun), possession of          thesia, were the medical service(s)
vices purchased from Dantor and             prohibited weapons and devices             actually rendered to the patients.
Clara Medical, knowing the insur-           (ammunition), and unlawful posses-         The indictment alleged that the false
ance companies would not pay the            sion of weapons (Oleoresin Capsi-          claims were submitted to several in-
bills if they had known he owned            cum). On July 23, 2003, Ottenstein         surance companies for both health
Dantor and Clara Medical. The in-           was arrested on the above refer-           and automobile insurance, including
dictment alleged that, in some in-          enced charges and bail was set in          Oxford Health Care, New Jersey
stances, the bills were fraudulent be-      the amount of $50,000. The                 Manufacturers Insurance Company,
cause they were inflated or they            Ottenstein case is pending grand           United Health Care and Allstate In-
were for equipment that was never           jury presentation.                         surance Company. This case is
provided to patients. In total, it is al-                                              pending trial.
leged that LeClerc and Lunic                State v.
Adisson fraudulently billed insurance       Richard Finder                             False Health Care Claims
carriers approximately $48,273, of               On November 10, 2003, Richard
which the Adissons were paid ap-            Finder, a former licensed chiroprac-
                                            tor, pled guilty to an Accusation          State v. Andrea Wahlig
proximately $26,028.
                                            charging him with health care claims            Andrea Wahlig was arrested by
      Lunic Adisson was also named
                                            fraud. Finder, who had operated the        OIFP investigators pursuant to a
in an unrelated indictment charging
                                            Family Chiropractic Clinic located in      complaint and summons charging
that, on December 13, 2002, in
                                            Fort Lee, admitted that, from January      her with health care claims fraud for
Irvington, she was in possession of
                                            through August of 2000, he submit-         submitting claims for prescription re-
a fictitious insurance identification
                                            ted over $1,260 in fraudulent bills to     imbursements to which she was not
card. It is alleged in that indictment
                                            the Cigna Insurance Company for            entitled. Wahlig subsequently pled
that she presented the fictitious in-
                                            chiropractic treatments that he never      guilty to an Accusation charging her
surance identification card to an
                                            rendered. Finder awaits sentencing.        with health care claims fraud. At the
Irvington police officer to regain
                                                                                       guilty plea hearing, Wahlig stated
possession of her car which had
                                                                                       that she had been injured at work
been impounded by the Irvington
                                                                                       and had received workers’ compen-
Police Department. Both cases are
                                                                                       sation benefits from New Jersey
pending trial.



                                                                                                                                119
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Manufacturers Insurance Company,         rier for Coach USA/O.N.E., for per-
                 which benefits paid for her medical      sonal injuries and was paid approxi-
                 treatment and prescription medica-       mately $3,000 for this claim. Butler
                 tions. Wahlig was also covered un-       pled guilty to theft by deception and,
                 der her husband’s prescription plan,     on January 17, 2003, he was sen-
                 which required a co-pay of $5 per        tenced to three years probation con-
                 filled prescription. Wahlig admitted     ditioned upon paying $3,740 in resti-
                 that, between 1997 and 2000, she         tution to Sedwick Claims Services
                 submitted false insurance claims to      and Aetna/US HealthCare.
                 New Jersey Manufacturers for full re-
                 imbursement of her prescription          State v. Donald Robison
                 medications, when, in fact, her               On February 13, 2003, a Passaic
                 husband’s prescription plan had paid     County Grand Jury returned an in-
                 for the prescriptions, less the $5 co-   dictment charging Donald Robison
                 pay. Because she failed to disclose      with health care claims fraud and
                 her husband’s prescription coverage,     theft by deception. According to the
                 New Jersey Manufacturers paid            indictment, Robison submitted three
                 Wahlig a total of $11,771 represent-     fraudulent health insurance claims to
                 ing the full cost of 18 prescription     AARP Health Care Options for treat-
                 transactions, when Wahlig should         ment he had not received at three
                 have only been reimbursed for her        Northern New Jersey hospitals. The
                 co-payments for the prescriptions.       indictment also alleged that Robison
                 On January 10, 2003, Wahlig was          knew that the claims were fraudulent
                 sentenced to five years probation        when he submitted them. Robison
                 conditioned upon paying $11,681 in       allegedly received a total of $2,880
                 restitution to New Jersey Manufac-       as a result of these fraudulent sub-
                 turers Insurance Company and or-         missions. On March 13, 2003,
                 dered to pay a $5,000 civil insurance    Robison failed to appear to answer
                 fraud fine.                              the charges and a bench warrant
                                                          was issued for his arrest. Robison’s
                 State v.                                 case is pending trial.
                 Brian Butler
                      A State Grand Jury returned an      State v. Patricia
                 indictment charging Brian Butler with    and Paul Sullivan
                 health care claims fraud and theft by         A State Grand Jury charged
                 deception. According to the indict-      Patricia and Paul Sullivan in connec-
                 ment, Butler falsely claimed to have     tion with the submission of fraudu-
                 slipped and fallen while a passenger     lent health care claims in two sepa-
                 on a Coach USA/O.N.E. bus operat-        rate indictments. The first indictment
                 ing in Elizabeth and fraudulently sub-   alleged that, between July 27, 2000
                 mitted an insurance claim to Aetna/      and November 2, 2000, Patricia
                 U.S. HealthCare for injuries purport-    Sullivan submitted fraudulent claims
                 edly sustained in the bus accident.      to MetLife Auto and Home Insurance
                 Aetna paid the claim money directly      Company in order to seek reim-
                 to Butler’s medical service providers.   bursement for prescriptions purport-
                 The indictment also alleged that But-    edly paid for by her, when, in fact,
                 ler fraudulently submitted an insur-     she was not entitled to reimburse-
                 ance claim to ACE Property and Ca-       ment for the cost of the prescriptions.
                 sualty Company, the insurance car-       The indictment also alleged that




120
Patricia Sullivan altered and/or falsified   Robert J. Berman                          State v.
prescription medication records in                On May 20, 2003, Robert J.           James Clark
support of the fraudulent claims. She        Berman pled guilty to an Accusation            On July 16, 2003, a State Grand
was charged in this indictment with          charging him with theft by deception.     Jury returned an indictment charging
health care claims fraud, theft by de-       Berman admitted that, between No-         James Clark with two counts of theft
ception, and destruction, falsification      vember 1, 1999 and December 29,           by deception and one count of health
or alteration of records relating to         2000, he submitted approximately 56       care claims fraud. Clark was the
medical care.                                health care reimbursement claims to       president of Home Health Care Cen-
     In a second, separate indictment,       Aetna Insurance Company. Of the           ter, Inc., (HHC), located in Hoboken,
Patricia was charged, along with her         $8,222 in claims submitted, Aetna         as well as the Director of the now de-
husband Paul Sullivan, with con-             paid Berman $3,082. Some of the           funct Medical Care Management,
spiracy, health care claims fraud, at-       claims were false, including claims       Inc., d/b/a Mile Square Medical
tempted theft by deception, and de-          for services purportedly rendered to      Group, formerly located in
struction, falsification or alteration of    his daughter who was not entitled to      Weehawken. HHC is a business that
records relating to medical care. The        health care coverage. Additionally,       delivers prescription medications
second indictment alleged that, be-          Berman inflated the amount of cer-        from pharmacies to persons’ homes
tween December 17, 2001 and March            tain claims in order to steal money       and is not licensed to dispense or
5, 2002, Patricia Sullivan, in concert       from Aetna Insurance. On July 24,         otherwise sell prescription medica-
with her husband, Paul Sullivan, con-        2003, Berman was sentenced to five        tions. Mile Square Medical Group
spired to defraud Blue Cross/Blue            years probation conditioned upon          was a medical facility staffed by vari-
Shield by submitting fraudulent insur-       paying $3,082 in restitution and a        ous physicians. Clark, himself, was
ance claims totaling over $75,000 for        $2,500 civil insurance fraud fine.        neither a medical service provider
reimbursement for prescriptions they                                                   nor a licensed pharmacist.
falsely claimed to have purchased            State v.                                       According to the indictment, be-
from Marquet Pharmacy. According             Ruth Schwartz                             tween December 1, 1996 and Sep-
to the indictment, they falsified                 A State Grand Jury returned an       tember 11, 1998, Clark misrepre-
medical records and submitted                indictment charging Ruth Schwartz         sented to Horizon Blue Cross/Blue
them to Blue Cross/Blue Shield in            with health care claims fraud and         Shield, third party claims administra-
support of their phony claim.                theft by deception. According to the      tor for the New Jersey State Health
     Subsequently, Patricia Sullivan         indictment, Schwartz submitted a          Benefits Program, that HHC was li-
pled guilty to health care claims            number of legitimate prescriptions to     censed to supply, dispense, and sell
fraud, theft by deception, and at-           several pharmacies, but intentionally     prescription medications which were
tempted theft by deception and Paul          did not pick them up or pay for them.     delivered to patients of Mile Square
Sullivan pled guilty to conspiracy. On       Schwartz submitted the prescriptions      Medical Group. According to the in-
May 30, 2003, Patricia Sullivan was          because she knew she would re-            dictment, Clark misrepresented to
sentenced to four years in State             ceive payment for the prescription        Horizon that HHC was, therefore,
prison and ordered to pay restitution        drugs from Horizon Blue Cross/Blue        entitled to payment or reimburse-
in the amount of $18,578 to Blue             Shield, administrator of her              ment from the State Health Benefits
Cross/Blue Shield and $14,258 to             husband’s prescription plan through       Plan for the cost of the medications.
MetLife, as well as a $25,000 civil in-      his employment as a union electri-        The indictment further alleged that,
surance fraud fine. On the same              cian, even if she never picked them       for many prescriptions HHC sold, it
date, Paul Sullivan was entered into         up. Schwartz was “reimbursed”             grossly inflated the cost over the
the PTI Program conditioned upon             $19,569 by Horizon for the prescrip-      usual and customary price for claims
paying restitution to Blue Cross/Blue        tions. Schwartz pled guilty to theft by   which it submitted to the State
Shield in the amount of $18,578 and          deception and, on November 11,            Health Benefits Program. The indict-
a $25,000 civil insurance fraud fine.        2003, was sentenced to three years        ment also alleged that Clark submit-
State v.                                     probation, and payment of restitution     ted fraudulent health care reimburse-
                                             in the amount of $19,569 and a            ment claims to Horizon Blue Cross/
                                             $5,000 civil insurance fraud fine.        Blue Shield and the State Health




                                                                                                                             121
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Benefits Program for prescription           moves unwanted hair, and submitted
                 medications that were neither dis-          numerous fraudulent health insur-
                 pensed nor delivered.                       ance claims to two insurance com-
                      The State intends to prove that        panies. It is alleged that Acquaire,
                 Clark submitted as many as approxi-         using the business name “High
                 mately 400 fraudulent insurance             Mountain Medical Center,” submitted
                 claims for various medications, ap-         fraudulent claims to United Health
                 proximately 330 of which may have           Group Insurance Company and
                 been for medications that were never        Aetna Insurance Company totaling
                 dispensed and never delivered to the        $908,843. The claims were alleged
                 patients. The total amount of fraudu-       to be fraudulent because Acquaire
                 lent billings allegedly submitted by        billed hair removal by means of elec-
                 Clark to Horizon Blue Cross/Blue            trolysis as though it was a reimburs-
                                                             able medical surgical procedure
                                                             known as a debridement which can
                                                             only be done by, or under the super-
                                                             vision of, a properly licensed medical
                                                             provider. Acquaire was not a li-
                                                             censed medical service provider,
                                                             was allegedly not qualified to per-
                                                             form medical or surgical procedures,
                                                             and would not have been authorized
                                                             to bill the insurance companies for
                                                             such procedures. Acquaire’s case is
                                                             pending trial.

                                                             State v.
                                                             Christine Schmidt
                                                             and Peter Schmidt
                 Shield and the State Health Benefits            Christine Schmidt pled guilty to
                 Program was in excess of $365,000,          an Accusation charging her with
                 of which Horizon paid more than             forgery. Schmidt admitted she had
                 $343,000. The fraudulent prescription       knowledge of pharmacy procedures
                 scheme allegedly involved at least          and submitted nine forged prescrip-
                 eight different patients. Clark’s case is   tions to the De Rosa Pharmacy and
                 pending trial.                              the Rossmore Pharmacy, both in
                                                             Newark. On August 11, 2003, she
                 State v.                                    was sentenced to three years pro-
                 Florence Acquaire                           bation. Peter Schmidt, Christine
                     On October 30, 2003, a State            Schmidt’s former husband, was ar-
                 Grand Jury returned an indictment           rested by OIFP investigators and
                 charging Florence Acquaire with two         charged with theft by deception and
                 counts of health care claims fraud,         forgery for forging blank prescription
                 two counts of attempted theft by de-        forms in the name of Dr. Ormond
                 ception, and two counts of theft by         Wilkie and submitting phony pre-
                 deception. According to the indict-         scription reimbursement claims of
                 ment, between July of 1998 and April        over $3,600 to Aetna Insurance. Pe-
                 of 2001, Acquaire rendered services
                 as an electrologist, a person who re-




122
ter Schmidt pled guilty to theft by de-    Criminal Justice’s Social Security and     ment, Dr. Kollmer submitted a waiver
ception and forgery and, on May 30,        Financial Crimes Units revealed that       of life insurance premiums claim to
2003, was sentenced to three years         Aggarwal’s purported disabilities were     UnumProvident, falsely claiming that
probation and payment of                   fraudulent and, during the time of the     he was totally disabled from the
restitution of $3,642 to Aetna             purported disability, Aggarwal had         practice of plastic surgery and was,
Insurance Company.                         been involved as an owner/operator of      therefore, entitled to have his life in-
                                           numerous businesses in the New Jer-        surance premiums waived. By doing
Fraudulent                                 sey/New York area. On October 24,          so, Kollmer allegedly stole life insur-
                                           2003, Aggarwal was sentenced to four       ance premium coverage worth
Disability Claims                          years in State prison, ordered to pay      $9,000. This case is pending trial.
                                           restitution in the amount of               Kollmer also faces charges under a
State v.                                   $1,150,717 and pay a $15,000 civil in-     prior indictment which charged him
Dr. Ngan Hirai                             surance fraud fine.                        with the theft of more than $300,000
     A State Grand Jury returned an                                                   of insurance monies from Sentry In-
indictment charging Ngan Hirai, a          State v.                                   surance Company and American
dentist licensed to practice in New        Michael Cicconetti                         General Insurance Company for al-
Jersey, with theft by deception for fil-        On February 24, 2003, Michael         legedly falsely claiming that he was
ing a fraudulent disability claim. Ac-     Cicconetti pled guilty to an Accusa-       totally disabled from practicing as a
cording to the indictment, Hirai con-      tion charging him with theft by de-        plastic surgeon when, in fact, he per-
tinued to practice dentistry while she     ception. In 1999, during the course        formed dozens of surgical proce-
falsely claimed to be disabled and         of his employment at International-        dures during the period of his
collected total disability insurance       Matex Tank Terminals located in            claimed disability.
payments of $155,399 pursuant to a         Bayonne, Cicconetti suffered a work
disability insurance policy issued         related injury to his shoulder, pro-       State v.
through General American Insurance         ceeded with a course of therapy, and       Barbara D. Dickens
Company. The insurance company             collected disability insurance ben-             On May 8, 2003, a State Grand
terminated her benefits after deter-       efits. Cicconetti admitted that, be-       Jury returned an indictment charging
mining that she had been practicing        tween June 3, 1999 and September           Barbara D. Dickens with theft by de-
dentistry despite the purported dis-       7, 1999, while collecting approxi-         ception and falsifying records. Ac-
ability. On February 10, 2003, Hirai       mately $4,216 in disability insurance      cording to the indictment, between
was admitted into the PTI Program          benefits from his employer and Lib-        April of 1997 and January of 1999,
conditioned upon performing 50             erty Mutual Insurance Company, he          Dickens represented to CIGNA In-
hours of community service.                was able to work and did actually          surance Company that she was to-
                                           work at a hardware store, despite          tally disabled and, as a result, unable
State v.                                   misrepresenting that his injury pre-       to maintain employment. Pursuant to
Surrinder Aggarwal                         vented him from working. Cicconetti        a long-term disability insurance
     On January 31, 2003, Surrinder        was sentenced on May 21, 2003, to          policy, CIGNA paid Dickens a total of
Aggarwal pled guilty to an Accusa-         two years probation conditioned            $25,305 in disability insurance ben-
tion charging him with theft by de-        upon paying restitution in the amount      efits. The indictment alleged that dur-
ception and falsifying or tampering        of $4,216 and a civil insurance fraud      ing the period in question, Dickens
with records. Aggarwal admitted that,      fine of $2,500.                            was, in fact, continuously employed
between March 1, 1991 and May 31,
                                                                                      and, therefore, ineligible to receive
2001, he fraudulently received dis-        State v. W.
                                                                                      disability insurance benefits.
ability insurance benefits totaling        Lance Kollmer                              Dickens’ case is pending trial.
more than $1 million under both So-             On March 26, 2003, a State
cial Security and a private disability     Grand Jury returned an indictment
insurance policy underwritten by           charging W. Lance Kollmer, a board-
Northwestern Mutual. A joint investi-      certified plastic surgeon, with theft by
gation by OIFP and the Division of         deception. According to the indict-




                                                                                                                             123
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 State v.                                State v.
                 Gerard M. Zaccardi                      Campbell Halleran
                      A State Grand Jury returned an         On December 2, 2003, a State
                 indictment charging Gerard M.           Grand Jury returned an indictment
                 Zaccardi with theft by deception        charging Campbell Halleran with
                 and falsifying records. The indict-     attempted theft by deception,
                 ment alleged that Zaccardi fraudu-      health care claims fraud, and falsi-
                 lently applied for disability insur-    fying records. According to the in-
                 ance benefits with the Social Secu-     dictment, on July 18, 2002,
                 rity Administration (SSA) following     Halleran, who was employed by
                 a “slip and fall” at his place of em-   Dick’s Sporting Goods, Inc., in
                 ployment, after termination of tem-     Moorestown, submitted a fraudu-
                 porary benefits payments from           lent workers’ compensation claim
                 workers’ compensation. On the           to his employer. Halleran allegedly
                 SSA application, Zaccardi claimed       claimed that he had injured his
                 an inability to return to work and      back the day before while moving
                 function normally at home due to        store inventory from the loading
                 his purported disability. After con-    dock to the interior of the store.
                 ducting an investigation which in-      The State intends to prove that, in
                 cluded surveillance, authorities de-    fact, another employee of Dick’s,
                 termined that during this time pe-      had moved the inventory, and that
                 riod, Zaccardi was employed at an       Halleran had not injured himself as
                 auto body shop and did not appear       he had claimed. The workers’ com-
                 to be disabled. Zaccardi pled guilty    pensation claim had been submit-
                 to both counts of the indictment        ted to the Chubb Group of Insur-
                 and, on September 19, 2003, was         ance Companies which denied the
                 sentenced to five years probation       claim and referred the matter to
                 and ordered to pay restitution in the   OIFP for further investigation.
                 amount of $49,287.                      Halleran’s case is pending trial.

                 State v.                                State v.
                 Jose Susana-Rosario                     Suzanne Shenk
                     On October 1, 2003, a State              On October 23, 2003, a Passaic
                 Grand Jury charged Jose Susana-         County Grand Jury returned an in-
                 Rosario with theft by deception. Ac-    dictment charging Suzanne Shenk
                 cording to the indictment, between      with theft by deception, forgery, and
                 December of 2002 and February of        falsifying documents. According to
                 2003, Susana-Rosario fraudulently       the indictment, between February 1,
                 received over $5,000 in workers’        2002 and May 14, 2002, Shenk
                 compensation benefits from Ameri-       wrongfully collected disability insur-
                 can Home Assurance Company              ance payments from Aetna Insur-
                 (AIG). It is alleged that Susana-       ance Company by concealing the
                 Rosario reported that he injured his    fact that she was not disabled and
                 back while performing his duties as     was working at a physician’s office.
                 an employee at Eastern Seaboard         The indictment also alleged that
                 Packaging in Edison when, in fact,      Shenk forged a letter and falsified
                 he sustained the injuries at home.      another letter in support of her dis-
                 Susana-Rosario’s case is                ability claims to Aetna Insurance.
                 pending trial.                          Shenk’s case is pending trial.




124
State v.                                  Health Insurance                         Ralph D’Avanzo admitted that he was
Albert H. Beebe                                                                    wrongfully enrolled in Coverall’s group
                                          Underwriting/Application
     Albert H. Beebe was charged by                                                health insurance policy, that he was
                                          Fraud                                    not a full-time employee of Coverall,
a State Grand Jury indictment with
theft by deception and falsifying                                                  and was, in fact, residing in Florida.
records. The indictment alleged that,     State v.                                 Ralph also admitted submitting
between December 11, 1997 and             Fred D’Avanzo                            $104,750 in insurance claims to Blue
May 24, 1999, Beebe committed             and Ralph D’Avanzo                       Cross/Blue Shield, of which Blue
theft in connection with his receipt of        On January 10, 2003, Fred and       Cross/Blue Shield paid $53,178.
insurance disability benefits when he     Ralph D’Avanzo were each sen-
knowingly failed to notify Hartford In-   tenced to three years probation con-     State v.
surance Company that he had also          ditioned upon completing 200 hours       Barry W. Kallenberg
begun to receive Social Security          of community service, paying                  On December 19, 2003, Barry
benefits. According to Beebe’s Hart-      $10,765 in restitution to Horizon Blue   Kallenberg pled guilty to an Accusa-
ford disability insurance policy, his     Cross/Blue Shield, and a $1,500 civil    tion which charged him with theft by
insurance disability benefits had to      insurance fraud fine. Fred D’Avanzo      deception. Kallenberg admitted that
be “coordinated” with any disability      had previously pled guilty to an Ac-     he created a fictitious business, pur-
benefits he also received from Social     cusation charging him with theft by      portedly a real estate management
Security. Beebe’s Hartford insurance      deception and falsifying or tampering    business, in order to purchase
disability benefits were to be reduced    with records while his brother, Ralph    group health insurance. On or about
if he also received disability benefits   D’Avanzo, had pled guilty to a sepa-     February 21, 1999, Kallenberg ap-
from the Social Security Administra-      rate Accusation charging him with        plied to Horizon Blue Cross/Blue
tion. The indictment also alleged that    theft by deception. Fred D’Avanzo        Shield of New Jersey for a small
in support of Beebe’s thefts, Beebe       was the president of Coverall Staff      employer health benefits policy in
allegedly falsely answered “no” to        Services, Inc., a temporary employ-      order to obtain health coverage at a
questions on a Hartford question-         ment agency located in Linden. He        lower premium employee group rate
naire which asked whether he was          admitted that, in October of 1995,       for five people who were not entitled
receiving, or expected to receive,        he obtained health insurance by          to the coverage because they were
Social Security benefits. Beebe is al-    means of a Small Group Health            not bona fide employees of a bona
leged to have wrongfully received         Benefits Policy insurance contract       fide business. The investigation re-
over $29,000 in disability benefits.      with Horizon Blue Cross/Blue Shield      vealed that, between January of
On January 24, 2003, Beebe was            of New Jersey. The health insur-         1996 and January of 1999, health
admitted into the PTI Program condi-      ance policy required that employees      insurance claims were submitted to
tioned on paying restitution of ap-       eligible for group health care ben-      Horizon Blue Cross/Blue Shield on
proximately $29,000.                      efits be permanent, full-time em-        behalf of the purported employees
                                          ployees who work a minimum of 25         totaling $111,500. Kallenberg is
                                          hours per week for Coverall. Be-         awaiting sentencing.
                                          tween September of 1997 and Octo-
                                          ber of 2000, Fred D’Avanzo wrong-
                                          fully obtained health insurance for
                                          his brother, Ralph, and two other
                                          persons under that policy by signing
                                          a New Jersey Small Employer Certi-
                                          fication falsely claiming that his
                                          brother, Ralph, and the two other
                                          persons were full-time employees of
                                          Coverall and worked 40 hours or
                                          more per week when, in fact, they
                                          were not full-time employees.




                                                                                                                         125
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Phony “Slip and Fall” Claims             Health Insurance Claims
                                                          Involving Identity Fraud
                 State v.
                 Bruce Robert Tarlowe                     State v.
                       Following a 12 day jury trial,     Mynerva Jean
                 Bruce Robert Tarlowe, a licensed in-          On June 4, 2003, Mynerva Jean
                 surance agent, was convicted of          pled guilty to an Accusation charging
                 health care claims fraud and at-         her with theft by deception. Jean ad-
                 tempted theft by deception for plan-     mitted that she took the health insur-
                 ning and staging a phony “slip and       ance benefits card issued to her sis-
                 fall” accident. The Union County jury    ter, Wendy Jean, and sought treat-
                 found Tarlowe guilty of falsely claim-   ment from a doctor. Mynerva Jean
                 ing that, on April 12, 1998, he          admitted that she fraudulently used
                 “slipped and fell” on a piece of let-    the card to obtain health insurance
                 tuce on the floor of the produce aisle   coverage in her sister’s name on
                 while shopping at the A&P Super-         three separate dates between De-
                 market in Union Township. Unaware        cember 24, 2001, and January 15,
                 that the phony “slip and fall” at the    2002. The treating medical service
                 supermarket was recorded on video-       provider submitted claims to State
                 tape by a store camera, Tarlowe had      Farm Insurance Company in the
                 further claimed that he sustained se-    amount of $1,415 and State Farm
                 rious and permanent injuries and         paid $877 for the treatments ren-
                 was unable to work as a result of        dered to Mynerva Jean while she
                 these injuries. The jury also found      was impersonating her sister. State
                 that, between April 12, 1998 and         Farm began the investigation when
                 March 10, 1999, Tarlowe submitted        Wendy Jean was questioned about
                 20 fraudulent health insurance           some of the medical services pro-
                 claims to the United States Life In-     vided and she advised State Farm
                 surance Company for medical bills        that she never received those medi-
                 totaling $5,730. As a result of these    cal services. Mynerva Jean was ad-
                 submissions, the United States Life      mitted into the PTI Program on July
                 Insurance Company paid out a total       24, 2003, conditioned upon perform-
                 of $3,002 to the medical service pro-    ing 60 hours of community service
                 viders. Tarlowe had also filed a civil   and paying a $4,000 civil insurance
                 suit against A&P in August of 1998       fraud fine.
                 which was dismissed by stipulation
                 of the parties in January of 1999. On    State v.
                 February 14, 2003, Tarlowe was           Norma Rivera
                 sentenced to three years in State        and Veronica Pantoja
                 prison and payment of restitution in         On January 30, 2003, Norma
                 the amount of $2,724 and a $1,000        Rivera and her daughter, Veronica
                 criminal fine.                           Pantoja, pled guilty to separate Ac-
                                                          cusations charging them with theft by
                                                          deception. Rivera and Pantoja ad-
                                                          mitted that, between November of
                                                          1999 and September of 2000,
                                                          Pantoja assumed Rivera’s identity in
                                                          order to obtain medical insurance to




126
cover dermatology treatments.            State v.                                 Insurance Related
Norma Rivera, who was covered un-        Michael Daye and Darryl Walker           Tax Fraud
der the State Health Benefits Plan            On April 2, 2003, a Hudson
through her husband, obtained a re-      County Grand Jury returned an in-
ferral for dermatology treatments
                                                                                  State v.
                                         dictment charging Michael Daye
from her primary care physician and                                               Dr. Samuel Evenstein
                                         and Darryl Walker with theft by de-
gave it to Pantoja, who assumed her                                                    Dr. Samuel Evenstein pled guilty
                                         ception. According to the indictment,
mother’s identity to obtain insurance                                             to an Accusation charging him with
                                         between June of 1999 and October
coverage for the dermatology treat-                                               three counts of failing to pay New
                                         of 1999, Daye assumed Walker’s
ments. Aetna and Blue Cross/Blue                                                  Jersey gross income tax with intent
                                         identity in order to obtain medical
Shield paid out over $800 for office                                              to evade payment. A joint investiga-
                                         treatments at the Khaleidoscope
visits and prescriptions. After their                                             tion between OIFP and the New Jer-
                                         Health Care/Parkside Medical Cen-
pleas, Rivera and Pantoja were ad-                                                sey Division of Taxation determined
                                         ter under Walker’s Horizon Blue
mitted into the PTI Program condi-                                                that Evenstein failed to report over
                                         Cross/Blue Shield insurance cover-
tioned upon paying restitution in the                                             $500,000 in income in 1999 and
                                         age. Khaleidoscope submitted bills
amount of $962 to the State Health                                                owed over $50,000 in New Jersey
                                         to Horizon Blue Cross/Blue Shield
Benefits Plan and serving 50 hours                                                State income taxes with respect to
                                         for Daye’s treatment in the amount
of community service.                                                             the unreported income. On January
                                         of $2,153, of which Horizon paid
                                                                                  24, 2003, Evenstein was admitted
                                         $1,564. Daye pled guilty to theft by
State v.                                                                          into the PTI Program conditioned
                                         deception and, on October 9, 2003,
Lenann L. Hill                                                                    upon paying restitution in the amount
                                         Daye was sentenced to two years
     On January 16, 2003, Lenann L.                                               of $71,748.
                                         probation, ordered to pay $1,564 in
Hill pled guilty to an Accusation        restitution, and a $1,000 civil insur-
charging her with identity theft. Hill   ance fraud fine. The indictment as       Life Insurance Fraud
admitted that, on October 4, 1999,       to Walker was dismissed on Octo-
she went to the emergency room at        ber 10, 2003. Walker was assessed        State v.
Wayne General Hospital and identi-       a civil insurance fraud penalty          Daouda Traore
fied herself as the wife of Clark        of $1,000.                                    On October 31, 2003, Daouda
Miller. At that time, Miller was em-                                              Traore was sentenced to two years
ployed by the County of Passaic and,                                              probation with 38 days jail credit and
as a county employee, he and his                                                  ordered to perform 75 hours of com-
wife were entitled to health care cov-                                            munity service after previously
erage under an insurance policy is-                                               pleading guilty to theft by deception
sued by Passaic County and admin-                                                 in conjunction with a scam to file
istered by Insurance Design Admin-                                                phony life insurance claims. At his
istrators. Hill, who had no insurance                                             plea hearing, Traore admitted that,
of her own, also admitted that, on                                                between December 15, 2000 and
October 5, 1999, using the name of                                                December 5, 2001, he purchased or
Miller’s wife, she had a surgical pro-                                            increased the benefits for two life in-
cedure done at Wayne General Hos-                                                 surance policies, one from AIG Life
pital. The total cost of services paid                                            Insurance Company and one from
out by Insurance Design Administra-                                               United Omaha Life Insurance Com-
tors for Hill’s medical treatment was                                             pany. Specifically, he admitted that,
$2,430. On the day of her guilty plea,                                            on December 15, 2000, he amended
Hill was admitted into the PTI Pro-                                               his life insurance policy with AIG Life
gram conditioned upon paying resti-                                               Insurance Company to include an
tution in the amount of $2,430 to                                                 additional death benefit of $125,000
Passaic County.                                                                   for a woman, Salimata Traore, who
                                                                                  he falsely claimed was his wife. He




                                                                                                                        127
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 also amended his AIG Life Insurance      State v.
                 Company policy to include additional     Mr. N.A. and Mrs. N.A.
                 death benefits of $50,000 for a boy,           On February 7, 2003, OIFP In-
                 Abdoulaye Traore, who he claimed         vestigators arrested Mrs. N.A. and
                 was his son. Additionally, Traore ad-    charged her with attempted theft by
                 mitted that, on December 26, 2000,       deception. The investigation re-
                 he purchased another accidental          vealed that, between November of
                 death life insurance policy from         1998 and June of 2002, Mrs. N.A.
                 United of Omaha Life Insurance           and her husband, Mr. N.A., whose
                 Company in the amount of $200,000        full names are withheld for investiga-
                 on the life of Salimata Traore, and in   tive reasons, falsely applied for 11
                 the amount of $20,000 on the life of     life insurance policies in the total ap-
                 Abdoulaye Traore. Finally, Traore        proximate amount of $5 million.
                 admitted that, on December 27,           Among the insurance companies vic-
                 2000, he purchased yet another           timized by this scheme were Valley
                 $12,000 life insurance policy for his    Forge Life Insurance Company
                 purported son, Abdoulaye Traore.         (CNA), Provident Mutual Insurance
                 Traore admitted that both his pur-       Company, First Colony Insurance,
                 ported wife and his purported son        Banner Insurance, North American
                 were fictitious persons, that he sub-    Casualty, Great American Insurance,
                 mitted false claims to the insurance     and Equitable Insurance. The inves-
                 companies that they had died acci-       tigation further revealed that Mr. and
                 dental deaths, and that the claims       Mrs. N.A. submitted death claims to
                 were submitted so that he could bilk     the insurance companies falsely
                 the insurance companies. Traore ad-      claiming Mr. N.A. died in Damascus,
                 mitted, in particular, that on January   Syria. They also submitted a false
                 4, 2001, he submitted a phony claim      death certificate in support of the
                 with AIG claiming that both his pur-     claims. When Mrs. N.A. was ar-
                 ported wife and his purported son        rested, her husband, Mr. N.A., re-
                 were killed in an automobile accident    mained a fugitive and was believed
                 in Africa. In support of the claim,      to be in Syria. On July 7, 2003, Mr.
                 Traore also submitted phony hospital     N.A. was arrested by OIFP investiga-
                 records, death certificate forms, and    tors on an outstanding warrant.
                 police reports substantiating the au-    On August 12, 2003, Mr. and Mrs.
                 tomobile accident and the deaths of      N.A. pled guilty, respectively, to two
                 his purported wife and son. The total    separate Accusations. The first Ac-
                 amount of fictitious claims submitted    cusation charged Mrs. N.A. with falsi-
                 by Traore was $407,000. Both insur-      fying records. Mr. N.A. was charged
                 ance companies denied the claims.        in the second Accusation with at-
                                                          tempted theft by deception. On Octo-
                                                          ber 24, 2003, Mr. N.A. was sen-
                                                          tenced to five years probation and
                                                          ordered to pay a $5,000 civil insur-
                                                          ance fraud fine. On the same date,
                                                          Mrs. N.A. was sentenced to five
                                                          years probation and also ordered to
                                                          pay a $5,000 civil insurance fraud
                                                          fine. She was also assessed a
                                                          $1,000 insurance surcharge.




128
State v.                                 Insurance                                  State v.
Patricia West                                                                       Douglas Ross
     Patricia West was charged in a      Professional Fraud                              On January 24, 2003, Douglas
State Grand Jury indictment with                                                    Ross, a licensed insurance agent
two counts each of theft by decep-       Insurance Agent Fraud                      and the owner and operator of Dou-
tion and uttering a forged instru-                                                  glas W. Ross Associates, was in-
ment. The indictment alleged that,       State v.                                   dicted by a State Grand Jury and
in June of 1998, Patricia West           Robert Massa, Massa                        charged with theft by failure to make
fraudulently represented herself to      and Miller Agency, Inc.,                   required disposition of property re-
be Christine Franklin, the benefi-                                                  ceived and simulating a motor ve-
                                         and the Associated Programs
ciary of a life insurance policy on                                                 hicle insurance identification card.
the life of Christine Franklin’s
                                         Agency, Inc.
                                                                                    Douglas W. Ross Associates is a
daughter, Desiree Franklin, who               Robert Massa, a former Ocean
                                                                                    commercial insurance brokerage
had died in a motor vehicle accident     County insurance agent, pled guilty
                                                                                    company which obtains insurance
on November 3, 1996. West alleg-         to an Accusation which charged him
                                                                                    coverage for its small business cli-
edly filed a fraudulent life insurance   with conspiracy and theft by decep-
                                                                                    ents by borrowing the funds from
claim with the State of New Jersey       tion. Massa was the former owner
                                                                                    premium financing companies and
Group Life Insurance Plan adminis-       and operator of two defunct insur-
                                                                                    then forwarding them to insurance
tered by Prudential Life Insurance       ance agencies known as the Massa
                                                                                    carriers for payment of the small
Company, which issued a death            and Miller Agency, Inc., and the As-
                                                                                    businesses’ insurance premiums.
benefits check in the name of Chris-     sociated Programs Agency, Inc.,
                                                                                    According to the indictment, between
tine Franklin in the amount of           both located in Lakewood. Both
                                                                                    February of 2001 and August of
$49,263. West allegedly endorsed         agencies also pled guilty to con-
                                                                                    2002, Ross fraudulently obtained
the check by forging Franklin’s          spiracy and theft by deception in
                                                                                    over $121,000 in loans from AMGRO
name and deposited the check into        separate Accusations. Massa admit-
                                                                                    Premium Financing Company alleg-
her own personal bank account.           ted that he conspired to fraudulently
                                                                                    edly to finance several insurance
                                         obtain and cash checks totaling ap-
     The indictment also charged that                                               policies. The indictment alleged that
                                         proximately $5.6 million from Na-
West fraudulently represented her-                                                  Ross obtained the loans by providing
                                         tional Premium Plan, A1 Credit Cor-
self to be Christine Franklin to the                                                false documentation representing
                                         poration, and Agency Services, Inc.,
State of New Jersey Division of Pen-                                                non-existent policies.
                                         insurance premium finance compa-
sions and Benefits in order to collect                                                   The indictment further alleged
                                         nies which lend small businesses
death claim benefits based on                                                       that Ross collected insurance pre-
                                         money to pay insurance premiums
Desiree Franklin’s prior public em-                                                 mium payments from five commer-
                                         for business coverage. On January
ployment. Prior to her death, Desiree                                               cial clients but failed to remit the pre-
                                         17, 2003, Massa was sentenced to
Franklin had been employed by                                                       miums to the insurance carriers, and
                                         five years in State prison. In addition,
Rutgers University and was entitled                                                 allegedly diverted the premium pay-
                                         Massa and his corporations, Massa
to various State benefits, including                                                ments to his own personal use. Ross
                                         and Miller Agency, Inc., and Associ-
survivor benefits for a designated                                                  pled guilty to the charges in the in-
                                         ated Programs, Agency, Inc., were
beneficiary. According to the indict-                                               dictment and, on September 22,
                                         ordered to pay $844,000 in restitu-
ment, West forged Christine                                                         2003, he was sentenced to five
                                         tion. The corporations were each
Franklin’s name on the death ben-                                                   years probation and ordered to pay
                                         sentenced to five years probation.
efits check issued to Franklin in the                                               $85,288 in restitution.
                                         Michael Miller and an attorney,
amount of $1,285 and deposited the
                                         Stanley Gulkin, were previously sen-
money in her personal bank account.
                                         tenced to State prison in connection
On August 11, 2003, West was ad-
                                         with the scam.
mitted into the PTI Program condi-
tioned upon paying $49,263 in resti-
tution to Prudential Life and perform-
ing 50 hours of community service.




                                                                                                                            129
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 State v.                                 used the money to pay his own per-
                 Harry DelBosco                           sonal expenses instead of forward-
                      On November 14, 2003, Harry         ing it to the insurance carrier.
                 DelBosco, a licensed insurance           Barleycorn was arrested in Louisiana
                 agent and former president of an in-     in August of 2002 and extradited to
                 surance agency known as Garden           New Jersey the following month to
                 State Brokers, Inc., was sentenced       answer the charges in the indict-
                 to five years in State prison and pay-   ment. Barleycorn pled guilty and, on
                 ment of $887,000 in restitution after    April 25, 2003, was sentenced to five
                 pleading guilty to an Accusation         years probation with credit for 249
                 charging him with theft by failure to    days served in county jail and pay-
                 make required disposition of prop-       ment of $1,000 in restitution.
                 erty received. Garden State Brokers,
                 Inc., formerly doing business in East    State v.
                 Hanover, was an insurance agency         Odell Coleman
                 that also brokered insurance pre-             On August 15, 2003, Odell
                 mium financing loans for small busi-     Coleman was sentenced to four
                 nesses, mainly in the trucking indus-    years in State prison and ordered to
                 try. Following an extensive OIFP in-     pay $101,657 in restitution to Allianz
                 vestigation, DelBosco admitted that      Life Insurance Company. Coleman,
                 he stole at least $887,000 entrusted     a Philadelphia resident who was an
                 to him by several premium finance        insurance agent licensed in New Jer-
                 companies, including AFCO Credit         sey, had previously pled guilty to an
                 Corp., First Insurance Funding Cor-      Accusation charging him with theft
                 poration and AMGRO Premium Fi-           by failure to make required disposi-
                 nancing, Inc. The funds had been         tion of property received and theft by
                 given to DelBosco to be used for the     deception. Coleman admitted that in
                 financing of insurance premiums on       his capacity as an insurance agent
                 behalf of numerous commercial            for Allianz Life Insurance Company
                 insureds. Instead, DelBosco misap-       of North America and LifeUSA Insur-
                 propriated and converted the funds       ance Company, he convinced a
                 to his own use.                          Moorestown woman to purchase an
                                                          annuity worth $100,000. Coleman
                 State v.                                 admitted that on August 16, 1999, he
                 Robinson D. Barleycorn                   accepted a check from the woman in
                      Robinson Barleycorn was             the amount of $100,000. Instead of
                 charged in a State Grand Jury indict-    submitting the money to Allianz and
                 ment with one count of theft by fail-    LifeUSA for the annuity, Coleman
                 ure to make required disposition of      deposited the check into his own
                 property received. The indictment al-    bank account for his personal use.
                 leged that, between June 1, 1994
                 and September 15, 1997,
                 Barleycorn, while acting as an insur-
                 ance agent for Capacity Marine In-
                 surance Agency, received $321,000
                 in insurance premium payments
                 from a Connecticut tugboat operator
                 to purchase marine insurance for the
                 corporation’s tugboat operation, but




130
State v.                                  dictment, between January of 2000          draw $45,000 from another insured’s
Farid S. Elgebaly                         and December of 2001, Span and             annuity account held at UNA. On
     On May 27, 2003, Farid S.            Kaplan stole approximately $20,000         September 2, 2003, Binczak pled
Elgebaly pled guilty to all counts of     by selling fictitious insurance policies   guilty to theft by deception and is
an indictment charging him with theft     to insurance purchasers, collecting        pending sentencing.
by deception, misapplication of en-       insurance premium monies from the
trusted property, and simulating a        purchasers, and failing to remit the       State v.
motor vehicle insurance identification    monies to the insurance companies.         Vito Grupposo
card, and to an Accusation charging            The indictment also alleged that,     On May 30, 2002, armed with an ar-
him with tampering with witnesses         between February of 2002 and May           rest warrant for Vito Grupposo and a
and informants. A bench warrant for       of 2002, Span distributed phony au-        search warrant to search his busi-
Elgebaly’s arrest was issued after he     tomobile insurance identification          ness premises located in
failed to appear for sentencing.          cards purportedly issued by the New        Parsippany, Cedar Knolls and Wash-
Elgebaly, a former licensed insur-        Jersey Personal Automobile Insur-          ington, New Jersey, OIFP investiga-
ance producer who transacted busi-        ance Plan (NJPAIP). It further al-         tors seized the books and records of
ness on behalf of the New Jersey          leged that, in November of 2000,           Grupposo’s insurance agency and
Personal Automobile Insurance Plan        Kaplan cashed a $4,000 check               insurance premium finance busi-
(PAIP), had accepted money from           drawn on a closed account, knowing         nesses. Grupposo, a licensed insur-
various individuals for automobile in-    that the bank would not honor the          ance agent, was arrested and
surance premiums but failed to remit      check. Span pled guilty to theft by        charged with three counts of theft by
the money to PAIP or secure auto-         deception and, on October 24, 2003,        failure to make required disposition
mobile insurance for the individuals      he was sentenced to three years            of insurance premiums obtained
who paid the premium money.               probation and ordered to pay restitu-      from several of his insurance cus-
Elgebaly also distributed fraudulent      tion in the amount of $6,740. The          tomers. Grupposo is alleged to have
insurance identification cards to         case as to Kaplan is pending trial.        wrongfully engaged in insurance pre-
some of his clients. Elgebaly’s insur-                                               mium financing transactions and to
ance producer’s license was revoked       State v.                                   have embezzled insurance premi-
in February of 2001.                      Joseph Binczak                             ums entrusted to him by insureds.
                                               A State Grand Jury indicted Jo-       Grupposo appeared before Judge
State v.                                  seph Binczak, an insurance agent           Bozonelis and bail was set in the
Stanley Span and Paul Kaplan              licensed in New Jersey, for theft by       amount of $100,000. The case is
     On July 17, 2003, Stanley Span       deception and falsifying records.          pending grand jury presentation.
and Paul Kaplan were named in a           According to the indictment, Binczak
State Grand Jury indictment. Span         was employed by the Ukranian Na-
was charged with conspiracy, theft        tional Association (UNA) as an in-
by deception, theft by failure to make    surance sales manager responsible
required disposition of property re-      for maintaining life insurance annu-
ceived, and simulating a motor ve-        ity accounts for members of UNA.
hicle insurance identification card,      The indictment alleged that, without
while Kaplan was charged in the           authorization, Binczak withdrew
same indictment with conspiracy,          over $600,000 from the annuity ac-
theft by deception, theft by failure to   counts of seven members of UNA
make required disposition of prop-        and converted the proceeds to his
erty received, and issuing bad            own use. Binczak also allegedly fal-
checks. Both defendants are li-           sified a letter dated September 14,
censed insurance agents and were          2000, authorizing him to withdraw
officers of the now defunct Span As-      $30,000 from an insured’s annuity
sociates Insurance Agency located         account held at UNA, and another
in Springfield. According to the in-      document authorizing him to with-




                                                                                                                           131
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 Insurance Carrier                         and been sentenced for, participating
                 Employee Fraud                            in the scheme with Prata. Of the ap-
                                                           proximately 43 co-conspirators
                                                           charged in the Prata scheme, eight
                 State v.                                  persons were sentenced to jail, and
                 Carl Prata, et al.                        the sentences of the others defen-
                      On August 25, 2003, Carl Prata       dants included probation or admis-
                 was sentenced to five years in State      sion to the PTI Program contingent
                 prison and ordered to pay $45,000 in      upon paying restitution and civil in-
                 restitution to Allmerica Insurance        surance fraud penalties.
                 Company and $5,000 in restitution to
                 St. Paul Insurance Company after          State v.
                 pleading guilty to conspiracy and theft   Mustafa Azme
                 by deception. Prata, formerly em-              On July 14, 2003, Prata co-con-
                 ployed as an insurance claims ad-         spirator, Mustafa Azme, was sen-
                                                           tenced to five years in State prison.
                                                           Azme had previously pled guilty to
                                                           an Accusation charging him with
                                                           conspiracy and theft by deception.
                                                           Azme admitted that, between Janu-
                                                           ary of 1998 and November of 2000,
                                                           he conspired with others to defraud
                                                           the Allmerica Insurance Company
                                                           and the St. Paul Insurance Com-
                                                           pany by claiming to have sustained
                                                           bodily injuries in automobile acci-
                                                           dents and fraudulently accepting in-
                                                           surance claim checks from the in-
                                                           surance companies for the claims.
                                                           Azme accepted one settlement
                 juster with the St. Paul Insurance        check in the amount of $12,500
                 Company and the Allmerica Insurance       from Allmerica and two settlement
                 Company, had been indicted by a           checks from the St. Paul Insurance
                 State Grand Jury and charged with         Company in the amounts of $10,000
                 conspiracy and theft by deception for     and $38,000. As part of the con-
                 allegedly issuing approximately 45        spiracy, Azme recruited nine per-
                 fraudulent bodily injury automobile in-   sons to receive fraudulent insurance
                 surance settlement checks totaling        claims checks. The nine persons re-
                 some $533,000 to conspirators who         cruited by Azme were issued nine
                 were not entitled to them. Prata would    insurance settlement checks total-
                 access his company’s claims com-          ing $113,500. Of the nine persons
                 puter and issue insurance claims          recruited by Azme, six have pled
                 settlement checks for injuries purport-   guilty to charges of conspiracy and/
                 edly sustained by people who had not      or theft by deception, while charges
                 actually been in automobile accidents.    against the remaining three persons
                 He would then accept part of the sto-     are pending. Azme also paid restitu-
                 len money as a kickback. In the           tion of $51,750 prior to his sentencing.
                 course of the investigation which
                 spanned several years, a number of
                 co-conspirators have pled guilty to,




132
State v. H.K.                              State v.                                 proceeds, and return the balance of
     On January 31, 2003, H.K., an-        Le T. Harlin                             the proceeds to her. Clements-
other Prata co-conspirator, whose full          On May 2, 2003, Le T. Harlin, a     Wright’s case is pending trial.
name has been withheld for investiga-      claims specialist in the Mount Laurel         As part of the investigation of
tive reasons, was sentenced to five        office of Ohio Casualty Insurance        Linda Clements-Wright, on March
years probation conditioned upon 178       Company, was sentenced to four           26, 2003, Neville, L. Holder, Lisa
days in county jail, and payment of        years in State prison and ordered to     Givens, Lisa’s husband George Giv-
restitution in the amount of $54,000       pay restitution to Ohio Casualty in      ens, and Bruce Alston pled guilty to
and a $10,000 civil insurance fraud        the amount of $101,869. Harlin had       separate Accusations charging them
fine. H.K. had pled guilty to an Accu-     pled guilty and admitted that, be-       with conspiracy. On March 28, 2003,
sation charging him with conspiracy,       tween July 17, 2000 and March 27,        Neville L. Holder’s son, Neville Louis
theft by deception, and terroristic        2002, he stole numerous checks           Holder, and Michael McCormick also
threats for his role in accepting six of   from third parties which were pay-       pled guilty to separate Accusations
the phony settlement checks in the         able to Ohio Casualty, forged en-        which also charged conspiracy. Each
amount of $54,000.                         dorsements on the checks using an        defendant admitted that between
                                           Ohio Casualty rubber stamp, and de-      July of 1995 and June of 1998, they
State v.                                   posited the checks into his Com-         accepted auto insurance related
Carol Cappuccio                            merce Bank account.                      claim checks in various amounts
     On September 19, 2003, another                                                 from Clements-Wright, knowing that
Prata co-defendant, Carol                  State v.                                 they were not entitled to the money.
Cappuccio, was sentenced to five           Linda Clements-Wright,                   On May 19, 2003, Neville L. Holder
years probation conditioned upon           Neville L. Holder, Lisa Givens,          and Neville Louis Holder were admit-
serving 90 days in county jail, and        George Givens, Bruce Alston,             ted into the PTI Program. Neville L.
ordered to pay $16,000 in restitution                                               Holder was ordered to pay restitution
                                           Neville Louis Holder,
as well as an $8,000 civil insurance                                                in the amount of $1,646, and Neville
                                           Marsha Alston Walker                     Louis Holder in the amount of
fraud fine. Cappuccio had previously
pled guilty to an indictment charging
                                           and Michael McCormick                    $6,354. On September 12, 2003,
her with conspiracy and theft by de-             On May 22, 2003, Linda             McCormick was sentenced to two
ception. Cappuccio was recruited by        Clements-Wright, an Allstate Insur-      years probation and ordered to pay
Mustafa Azme and accepted a                ance Company Insurance Claims            $11,342 in restitution. On October
fraudulently obtained settlement           Process Specialist working out of        24, 2003, Alston was sentenced to
check issued by Allmerica Insurance        Allstate Market Claims offices in        three years probation conditioned
Company in the amount of $16,000           Mount Laurel and Moorestown, was         upon the payment of $8,825 in resti-
for a purported accident in which she      charged by a State Grand Jury with       tution. On October 31, 2003, Lisa
was not involved. Cappuccio depos-         conspiracy, theft by unlawful taking,    Givens was sentenced to three years
ited the settlement check into her         and money laundering. According to       probation conditioned on paying
bank account and kept $4,000 after         the indictment, between April of 1995    $11,298 in restitution and also pay-
giving $12,000 to Azme. Cappuccio          and September of 1998, Clements-         ing a $15,000 civil insurance fraud
also recruited three other persons to      Wright, in her capacity as a Claims      fine. On October 31, 2003, George
participate in the conspiracy. Those       Processing Specialist for Allstate In-   Givens was also sentenced to three
three received settlement checks to-       surance Company, issued approxi-         years probation conditioned upon
taling $23,500 and have also pled          mately 150 Allstate insurance claim      paying restitution in the amount of
guilty to theft by deception for their     checks totaling approximately            $14,674 and a $15,000 civil insur-
roles in the conspiracy.                   $594,369 to 11 persons she was ac-       ance fraud fine.
                                           quainted with, but who were not en-
                                           titled to the insurance claim money.
                                           It is alleged that Clements-Wright
                                           conspired with her acquaintances to
                                           cash the checks, keep 10% of the




                                                                                                                         133
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 State v.                                  after keeping $800 for herself, she
                 Tara Mack                                 turned over the balance of the pro-
                      On May 13, 2003, Tara Mack, a        ceeds to Williams. She was admitted
                 financial support technician for Pru-     into the PTI Program subject to mak-
                 dential Insurance, pled guilty to an      ing restitution, maintaining gainful
                 Accusation charging her with theft.       employment, and cooperating in
                 Mack admitted that, between Febru-        OIFP’s prosecution of Williams.
                 ary of 2001 and April of 2001, during
                 the course of her employment as a         Public Insurance
                 financial support technician for Pru-     Adjuster Fraud
                 dential Insurance Company, she
                 stole seven checks from Prudential
                                                           State v.
                 totaling approximately $14,135, and
                                                           Marc Rossi, Otis Boone,
                                                           Michael Winberg
                                                           and Marc Graziano
                                                                On November 10, 2003, Marc
                                                           Rossi, the alleged leader of an “ar-
                                                           son for hire” ring, pled guilty to
                                                           charges of arson, conspiracy to com-
                                                           mit arson, bribery, theft, and theft by
                                                           deception. In pleading guilty to the
                                                           charges, Rossi admitted that he con-
                                                           spired with other co-conspirators to
                                                           damage or set fire to various proper-
                                                           ties so that he could solicit the victims
                                                           as clients for his public adjusting busi-
                 diverted them to a business account       ness, Rossi Adjustment Services. In
                 controlled by another person. On          particular, Rossi admitted his role in
                 July 1, 2003, Mack was sentenced to       six arsons involving two commercial
                 18 months probation conditioned           properties and four residential proper-
                 upon completing 75 hours of               ties. Rossi is pending sentencing.
                 community service.
                                                                Rossi’s other co-conspirators
                                                           have previously pled guilty. On De-
                 State v.
                                                           cember 12, 2003, Otis Boone, an
                 Jemal Williams
                                                           employee of Rossi Adjustment Ser-
                      On November 21, 2003, Jemal
                                                           vices, was sentenced to four years in
                 Williams was sentenced to three
                                                           State prison for participating in the
                 years probation and payment of
                                                           setting of the arson fires as part of
                 $3,982 in restitution for fraudulently
                                                           the Rossi conspiracy. On October
                 issuing insurance claims checks
                                                           31, 2003, Michael Winberg, also a
                 while working as a claims represen-
                                                           licensed public adjuster, was sen-
                 tative for Great West Life and Annu-
                                                           tenced for aggravated arson to five
                 ity Insurance Company. Williams ad-
                 mitted at his prior guilty plea hearing
                 that he had issued six fraudulent
                 checks totaling $7,415 to Letticia
                 Waymer. Waymer pled guilty to the
                 conspiracy in 2002, explaining that,




134
years in State prison, payment of        State v.                                   allegedly, the previous damage had
$102,000 in restitution and a $5,000     Oscar Medina                               not been repaired by T&K Kitchens
civil insurance fraud fine. On March          On March 6, 2003, OIFP investi-       and the invoice did not accurately re-
21, 2003, Marc Graziano, former          gators arrested Oscar Medina, an in-       flect the repairs done. It was further
owner of Graziano Florist, was sen-      surance claims adjuster employed at        alleged that Taintor submitted the
tenced for theft by deception and        Liberty Mutual Insurance Company,          forged invoice to obtain a larger
conspiracy to five years probation       and charged him with theft by decep-       commission in his capacity as the
and payment of $26,468 in restitu-       tion. Medina allegedly contacted in-       public insurance adjuster represent-
tion and a $2,500 civil insurance        surance claimants involved in auto-        ing the insured in settling the insur-
fraud fine.                              mobile accidents and advised them          ance claim. On June 5, 2003, Taintor
                                         that they would be able to obtain a        was admitted into the PTI Program
State v.                                 larger claim settlement by paying          conditioned upon completing 100
William Kiernan, Jr.                     him a fee rather than hiring an attor-     hours of community service and pay-
     Related to the Rossi investiga-     ney. The arrest warrant alleged that       ing restitution to his client, Curtis
tion and the Jeffrey Nemes investi-      Medina stole $5,500 by falsely creat-      Boykins, in the amount of $3,743.
gation (set forth elsewhere in this      ing the impression that, as a Liberty
Report), on December 17, 2003,           Mutual Group Claims Adjuster, he
William Kiernan, Jr., Chief of
                                                                                    Insurance Premium Fraud
                                         was entitled to 15% of the claimants’
Hamilton Township Enterprise Fire        bodily injury insurance settlement
Company, pled guilty to an Accusa-                                                  State v.
                                         money. This case is pending grand
tion charging obstructing the adminis-   jury presentation.                         Philip A. McKeaney
tration of law. Kiernan admitted pro-                                                    On November 17, 2003, Philip
viding false statements to law en-       State v.                                   McKeaney pled guilty to theft by fail-
forcement authorities during the         William R. Taintor, III                    ure to make required disposition of
course of an investigation into alle-         William R. Taintor, III, a licensed   property received and to a related
gations that Rossi and Nemes were        public insurance adjuster, was             but separate charge of misapplication
paying bribes and soliciting fire        charged in two separate State Grand        of entrusted property. A State Grand
chiefs to allow fires to burn longer     Jury indictments. The first indictment     Jury had previously charged
and do more damage so that the           charged Taintor with theft by failure      McKeaney, the operator of Haddon
amount of insurance claims would         to make required disposition of prop-      National Companies, Inc., (HNC),
be higher, thus allowing both            erty and alleged that, in September        with financial facilitation of criminal
Nemes and Rossi to reap greater fi-      of 2001, Taintor received an insur-        activity (money laundering), theft by
nancial benefits. Nemes would ben-       ance claim settlement check in the         failure to make required disposition
efit because his home repair con-        amount of $3,743 on behalf of an in-       of property received, and theft by de-
tracting business, Nemes Enter-          sured and kept the proceeds for him-       ception. HNC was a corporation that
prises, would potentially receive        self. The second indictment charged        served as a third party health insur-
larger contracts, and Rossi’s public     Taintor with attempted theft by de-        ance administrator. Third party
adjusting insurance business would       ception and forgery. According to          health insurance administrators re-
be awarded larger fees based on          that indictment, Taintor submitted a       ceive money to pay claims from em-
higher insurance claims. Kiernan’s       forged invoice to Omaha Property           ployers, corporations, and some-
sentencing is scheduled for              and Casualty Insurance Company             times government entities which self-
early 2004.                              bearing the purported signature of         fund and self-insure the health insur-
                                         another insured that Taintor repre-        ance plans that provide health ben-
                                         sented in order to inflate a property      efits to their employees. HNC, as a
                                         damage claim. The allegedly phony          third party administrator, was under
                                         invoice, dated October 10, 1995,           contract to receive money from its
                                         purported that T&K Kitchens had            self-insured clients for health insur-
                                         previously repaired damage to the          ance benefits, deposit that money,
                                         property located in Avalon. However,       and pay the health insurance claims
                                                                                    of its clients as they were submitted.




                                                                                                                          135
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 HNC would earn a fee for health insur-    Contractor’s Fraud
                 ance claims paid. In some cases,
                 HNC also received money from its          State v.
                 clients to purchase special re-insur-
                                                           Jeffrey Nemes
                 ance policies to provide health insur-
                                                                 On February 19, 2003, following
                 ance coverage.
                                                           a five week jury trial in Mercer
                      According to the indictment,
                                                           County Superior Court, Jeffrey
                 McKeaney stole in excess of $1 mil-
                                                           Nemes was found guilty of theft by
                 lion from nine clients, which should
                                                           failure to make required disposition
                 have been used to pay health insur-
                                                           of property. While employed as a
                 ance claims or purchase re-insur-
                                                           Hamilton Township police officer,
                 ance policies. Some of the stolen
                                                           Nemes, owner of Nemes Enter-
                 money was used to pay McKeaney’s
                                                           prises, Inc., a home repair contract-
                 personal debts and expenses, and
                                                           ing business, took insurance claims
                 some of it was transferred to another
                                                           money totaling approximately
                 business, Cambria Corporation, in
                                                           $122,000 from both commercial and
                 which McKeaney had an interest.
                                                           residential property owners purport-
                 The indictment also specifically al-
                                                           edly to make repairs on their proper-
                 leged that McKeaney committed the
                                                           ties through his home repair con-
                 crime of money laundering by trans-
                                                           tracting business but failed to com-
                 ferring approximately $494,188 from
                                                           plete the repairs to the properties or
                 his company, HNC, which money
                                                           return the money. On May 30, 2003,
                 should have been used to pay health
                                                           Nemes was sentenced to seven
                 care claims or procure health insur-
                                                           years in State prison and ordered to
                 ance policies for clients, to Cambria
                                                           pay a total of $130,833 in restitution.
                 Corporation, a business in which
                                                           Nemes’ conviction is presently
                 McKeaney had an interest.
                                                           on appeal.
                 McKeaney is scheduled to be
                                                                 More recently, on December 18,
                 sentenced in 2004.
                                                           2003, a State Grand Jury returned
                 State v.                                  another indictment against Nemes
                                                           charging him with bribery in official
                 Nunzio Tartaglio
                                                           and political matters. This indictment
                      On August 27, 2003, Nunzio
                                                           charged Nemes with offering two
                 Tartaglio pled guilty to an Accusation
                                                           bribes to local fire chiefs allegedly to
                 charging him with theft by failure to
                                                           enhance property damage in the
                 make required disposition of prop-
                                                           course of extinguishing fires. The
                 erty received and was admitted into
                                                           first bribe allegedly occurred on April
                 the PTI Program conditioned upon
                                                           22, 1998, when Nemes is alleged to
                 paying $9,000 in restitution.
                 Tartaglia, a former insurance agent
                 for the Nettis Insurance Agency, ad-
                 mitted that he collected life insurance
                 premium payments from insurance
                 purchasers and failed to remit the
                 premium payments to the insurance
                 carriers. He also admitted that auto-
                 matic policy loans were initiated on
                 the policies without the owners’
                 knowledge or consent so he could
                 steal the loan proceeds.




136
have offered cash to the Fire Chief of    upon paying $200 in restitution to     insurance claim following a burglary at
the Rusling Hose Fire Company. The        the State of New Jersey.               his home on December 10, 2001.
second bribe is alleged to have oc-
curred following a conspiracy in which                                           State v.
Nemes and Marc Rossi, the former
                                          Property Related                       Steven Budge, John Budge
owner of Rossi Adjustment Services,       Insurance Fraud                        and Frank Land
a public insurance claims adjusting                                                   On February 26, 2003, a State
business, agreed to offer a bribe to
                                          False Homeowners                       Grand Jury returned an indictment
Fire Chief William Kiernan, Jr., of the                                          charging Steven Budge, a Public
Enterprise Fire Company located in        Insurance Claims
                                                                                 Insurance Claims Adjuster; his brother,
Hamilton Township, New Jersey. The                                               John Budge; and their uncle, Frank
State intends to prove at trial that      State v.                               Land, with attempted theft by
cash bribes were offered to the Chiefs    Tracy D. Childress                     deception. According to the
so that they would allow additional            Tracy D. Childress, a Newark      indictment, on or about December 12,
damage to be done to buildings by         police officer, was charged by an      2000, a house owned by Frank Land
permitting fires to burn longer while     Essex County Grand Jury in 2002        was damaged as a result of winds that
supposedly working to extinguish          with attempted theft by deception      caused a large tree limb to fall on the
those fires. Nemes is pending trial       relating to a false insurance claim    roof. It is alleged in the indictment that
with respect to the charges under this    for a laptop computer allegedly sto-   Steven Budge, John Budge, and Frank
latter indictment.                        len from his home. According to the    Land inflicted additional damage to the
                                          indictment, Childress submitted a      roof in order to inflate the homeowner’s
Insurance                                 false receipt to his insurance com-    insurance claim to Liberty Mutual
                                          pany, purporting to substantiate the   Insurance Company. The State
Inspection Fraud                          purchase of a computer costing in      intends to prove that Steven Budge
                                          excess of $7,282. Childress alleg-     submitted an appraisal to repair the
State v.                                  edly submitted the receipt to Cigna    roof to Liberty Mutual which was
Waleed Itani                              Insurance Company as support for       inflated by approximately $60,000.
     Waleed Itani pled guilty to an Ac-   a homeowner’s insurance claim in       Liberty Mutual, suspecting fraud,
cusation charging him with commer-        which he claimed that a burglary oc-   denied the claim, and referred the case
cial bribery. In February 2000, Itani     curred at his residence and that       to OIFP for further investigation. The
was employed at George’s Shell, a         some of his personal property was      cases are pending trial.
service station in Hackensack, which      stolen, including the computer. On
was also an authorized CARCO in-          March 3, 2003, Childress was ad-       State v.
surance inspection facility. CARCO        mitted into the PTI Program condi-     Lisa Mulrooney
is an independent vendor for the au-      tioned upon completing 50 hours of         On May 22, 2003, Lisa Mulrooney
tomobile insurance industry which         community service.                     pled guilty to an Accusation charging
contracts with service stations to in-
                                                                                 her with attempted theft by deception.
spect used automobiles to assess          State v.
                                                                                 Mulrooney admitted that on October 1,
their condition for the purpose of cal-   Robert Stevens                         2001, she altered a $126 invoice
culating insurance coverage and pre-           On March 14, 2003, Robert         issued by Aqua Pure, Inc., a company
miums. Itani admitted that as an          Stevens was sentenced for forgery      which delivered water to Mulrooney’s
agent of CARCO, he accepted $200          to two years probation conditioned     residence, to read $3,316. She
to falsify a CARCO inspection report      upon paying a $1,000 civil insurance   submitted the altered invoice to State
to indicate that a 1995 Toyota Co-        fraud fine and a $350 criminal fine.   Farm in support of a property damage
rolla contained a stereo AM/FM ra-        Stevens admitted that he submitted     claim after fuel oil leaked from an
dio with tape deck, compact disc          a forged receipt from Eagle Golf       underground tank on her property and
player, and alarm system. On Feb-         Works in the amount of $1,004 to       contaminated her water supply. On
ruary 28, 2003, Itani was admitted        AAA Mid-Atlantic Insurance Com-        August 22, 2003, Mulrooney was
into the PTI Program conditioned          pany, in support of a homeowner’s      admitted into the PTI Program with the




                                                                                                                        137
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 conditions that she perform 60 hours of   Fraudulent
                 community service and pay a $5,000
                 civil insurance fraud fine.
                                                           Property Claims

                 State v.                                  State v.
                 David Rozjabek                            Solomon Bouzaglou,
                      On December 4, 2003, a               Joseph Benlolo and Effy Harari
                 Middlesex County Grand Jury returned           On March 12, 2003, Solomon
                 an indictment against David Rozjabek,     Bouzaglou and Joseph Benlolo pled
                 charging him with attempted theft by      guilty to separate Accusations charging
                 deception. According to the               each of them with conspiracy and
                 indictment, on May 24, 2002, an           attempted theft by deception.
                 automobile accident occurred near         Bouzaglou and Benlolo admitted that,
                 Rozjabek’s home which caused minor        between September of 1997 and May
                 damage to his landscaping. The            of 1998, they conspired with others,
                 indictment alleged that Rozjabek          including a public insurance adjuster,
                 submitted a property damage               to intentionally cause water damage to
                 insurance claim to his homeowner’s        costume jewelry stored in a warehouse
                 insurance carrier, Allstate Insurance     located in Irvington, which was
                 Company, using a phony invoice in the     insured by Fireman’s Fund Insurance
                 amount of $1,250 in support of his        Company for $1 million. The
                 claim. According to the indictment, the   defendants admitted that they
                 actual damage to Rozjabek’s property      submitted an insurance claim to
                 was estimated at $125. Rozabek’s          Fireman’s Fund for approximately
                 case is pending in trial.                 $973,638, knowing that the jewelry
                                                           had intentionally been damaged.
                 State v.                                  Fireman’s Fund, suspecting the claim
                 Carmina Vicidomini                        was fraudulent, denied the claim and
                      Carmina Vicidomini pled guilty to    referred the matter to OIFP for further
                 an Accusation charging her with           investigation. Sentencing is scheduled
                 attempted theft by deception and, on      for early 2004.
                 September 12, 2003, was admitted into          As part of the OIFP investigation
                 the PTI Program conditioned upon          into the Bouzaglou and Benlolo false
                 paying a $2,000 civil insurance fraud     claims, Effy Harari pled guilty to an
                 fine and performing 50 hours of           Accusation charging him with
                 community service. Vicidomini             conspiracy. Harari admitted that he
                 admitted that, on July 17, 2002, she      gave Benlolo $12,000 to finance the
                 filed a fraudulent property loss claim    scheme. Harari was, in turn, promised
                 with her homeowner’s insurance,           a portion of the insurance proceeds.
                 Selective Insurance Company,              On October 10, 2003, Harari was
                 claiming that jewelry valued at           admitted into the PTI Program
                 $4,980 had been lost. The                 conditioned upon performing 50 hours
                 investigation revealed that, in July of   of community service. He was also
                 2000, Vicidomini had filed an             ordered to pay a $5,000 civil insurance
                 insurance claim for the loss of the       fraud fine.
                 same jewelry under her automobile
                 policy but it was not covered.




138
State v. Mitchell Markowitz,               numerous international flights. Three      State v.
Sol Zaltz, Yehudah Berger,                 travel insurance companies, World          Eric Rosenblatt
Sam Nisser and David Nisser                Access Service Corporation/Access               On October 1, 2003, Eric
     On June 20, 2003, as part of the      America, Travel Insured Interna-           Rosenblatt was sentenced to five
Bouzaglou and Benlolo investigation,       tional, Inc., and Travel Guard Inter-      years probation conditioned on
Mitchell Markowitz, Sol Zaltz,             national, paid R.K. a total of $15,636     paying a $5,000 civil insurance fraud
Yehudah Berger, Sam Nisser, and            before suspecting that the claims          fine and performing 30 days of
David Nisser were charged in a             were fraudulent. R.K. also admitted        community service after pleading
State Grand Jury indictment with           that she used the letterhead and sig-      guilty to theft by deception. In May of
conspiracy and attempted theft by          nature of an Alitalia Airlines em-         2001, Rosenblatt had submitted a
deception. According to the indict-        ployee to create a letter which falsely    claim to Jewelers Mutual Insurance
ment, between January of 1998 and          indicated that Alitalia was unable to      alleging that he lost a one-carat
January of 1999, the defendants            locate R.K.’s missing luggage and          diamond ring valued at approximately
conspired to purchase 20,000 pieces        would forward a settlement check to        $5,700. An investigation by Jewelers
of inexpensive costume jewelry, pro-       R.K. for the maximum amount of the         Mutual revealed that previously, in
duce phony receipts, store the jew-        airline’s liability. As part of her par-   November of 2000, Rosenblatt had
elry in a warehouse, and purposely         ticipation in the PTI Program, R.K.        reported the same diamond ring lost
damage the jewelry in order to col-        was required to cooperate with the         to State Farm Insurance Company,
lect on the insurance policy. The          State in other investigations, pay a       which had paid him $4,664.
Irvington warehouse was insured by         $5,000 civil insurance fraud fine, and     Rosenblatt failed to disclose the prior
Fireman’s Fund Insurance Company           pay $10,447 in restitution to World        State Farm claim on the Jewelers
for $1 million. According to the indict-   Access Service Corp., $2,170 in res-       Mutual application for insurance.
ment, Markowitz, a licensed public         titution to Travel Insured Interna-        Jewelers Mutual denied Rosenblatt’s
insurance adjuster, submitted an in-       tional, as well as $3,019 in restitution   May 2001 claim and referred the
flated insurance claim in the amount       to Travel Guard International.             matter to OIFP for investigation.
of $973,638 to Fireman’s Fund. The
cases as to these five defendants          State v.                                   Phony
are pending trial.                         Daniel Chace                               Certificates/Letters
                                                On September 2, 2003, Daniel
State v. R. K.                             Chace was admitted into the PTI            of Insurance
     On July 17, 2003, R.K., whose         Program conditioned on performing
full name must be withheld for inves-      30 hours of community service after        State v.
tigative reasons, was admitted into        pleading guilty to attempted theft.        William Burgermaster
the PTI Program after being charged        Chace, who was an operations engi-              William Burgermaster pled
by way of an Accusation on April 30,       neer at the World Trade Center, ad-        guilty to an Accusation charging him
2003, with theft by deception, at-         mitted that, in April of 2002, he sub-     with forgery. He admitted that, as an
tempted theft by deception, and forg-      mitted a fraudulent property loss          employee of Shading Systems, Inc.,
ery. The Accusation charged that,          claim to Ohio Casualty Insurance           during a routine insurance audit of
between March of 1993 and May of           Group for the loss of what he              workers’ compensation insurance
2001, R.K. submitted phony insur-          claimed were his personal hand             coverage, he provided the auditors
ance claims for lost luggage and           tools, power tools, and clothing due       with a forged Certificate of Liability.
their contents under various travel/       to the terrorist attacks at the World      The certificate was purportedly is-
baggage insurance policies following       Trade Center on September 11,              sued by the Waldorf Insurance
                                           2001. Chace claimed the value of           Agency and purported to reflect
                                           the property loss at $5,824. The           proof of workers’ compensation in-
                                           tools and uniforms, however, were          surance, when, in fact, Shading
                                           not Chace’s personal property but          Systems, Inc.’s Certificate of Liabil-
                                           were, in fact, supplied by his em-         ity Insurance had been canceled
                                           ployer. Consequently, he was not,          due to non-payment. Under State
                                           entitled to file the claim.




                                                                                                                            139
      OIFP Criminal Case Descriptions –
      Insurance Fraud


                 law, workers’ compensation insur-           State v.
                 ance is mandatory. On May 14,               William Mulholland
                 2003, Burgermaster was admitted                  William Mulholland, the operator
                 into the PTI Program conditioned            of a small independent trucking com-
                 upon completing 50 hours of                 pany known as Bilco Transport, pled
                 community service.                          guilty to an Accusation which
                                                             charged him with forgery. Mulholland
                 State v.                                    admitted that, on March 4, 2002, in
                 Mark DiTaranto                              order to enter into a business agree-
                      On September 26, 2003, Mark            ment with Furniture King Stores, he
                 DiTaranto was sentenced to three            produced a forged letter purportedly
                 years probation and ordered to per-         from State Farm Insurance Com-
                 form 50 hours of community service          pany, stating that Bilco Transport
                 after pleading guilty to forgery by ut-     maintained a general liability insur-
                 tering. DiTaranto had presented a           ance policy with State Farm, that
                 forged Certificate of Liability Insur-      Furniture King Stores was added to
                 ance, purportedly issued by the Gen-        the policy as an additional insured,
                 eral Agents Insurance Company, to           and that Furniture King Stores was
                 a homeowner in order to perform             covered for losses of up to $500,000.
                 construction work at the                    Mulholland’s company, Bilco Trans-
                 homeowner’s residence.                      port, did not, in fact, maintain a gen-
                 State v.                                    eral liability insurance policy with
                 Douglas Pelikan                             State Farm. On May 5, 2003,
                       Douglas Pelikan pled guilty to an     Mulholland was admitted into the PTI
                 Accusation which charged him with           Program conditioned upon complet-
                 forgery. He admitted that, in June of       ing 75 hours of community service.
                 2002, he presented a fraudulent Cer-
                 tificate of Liability Insurance, purport-   State v.
                 edly issued by Nottingham Insurance         Anthony Spano
                 and Financial Service, to a client               On June 13, 2003, Anthony
                 who had hired Pelikan for a con-            Spano was sentenced to two years
                 struction project. Contractors are of-      probation conditioned upon paying
                 ten required to present Certificates of     $307 in restitution and $5,000 in
                 Insurance substantiating liability and      civil insurance fraud fines after
                 workers’ compensation insurance,            pleading guilty to committing theft
                 among others, before beginning con-         by deception. Spano admitted that,
                 struction work. Pelikan admitted that       between July 13, 1999 and March 1,
                 he altered the Certificate of Liability     2000, while working as a massage
                 to reflect current coverage because         therapist at the Circle of Health
                 his liability insurance policy with         Clinic, Inc., in Hillsdale, he fraudu-
                 Nottingham had previously been              lently submitted insurance claims to
                 canceled. On October 31, 2003,              Chubb Insurance for approximately
                 Pelikan was admitted into the               29 massage therapy sessions in
                 PTI Program.                                excess of $5,000.




140
Criminal Cases Investigated in 2003
by Fraud or Provider Type
                                                   - Staged Thefts/Give Up Schemes 118
                                                   - Fraudulent Insurance Cards 76
                                                   - Other 54
 - Miscellaneous 55
                                                   - Health Care/PIP/BI 38
 - False Documents 32
                                                   - False Claims 34
 - Agent Fraud 25
 - Property 13                                     - Staged Accidents 30
                                                   - Fraudulent Drivers Licenses 26
 - False Claims 12
                                                   - False Documents 17
 - Premium Theft 11
 - Homeowners Insurance 10




                              Property
                             & Casualty
                                158
                                                 Auto Fraud
                                                    393
               Medicaid
                 161


                                 Health & Life
                                     306
- Medical Support Other 27
- Pharmacy 24
- Transportation 21
- Facility Other 20
- Practitioners 18                                   - Health Care Claims Fraud 131
- Program Other 15                                   - Disability Insurance/
- Clinic 9                                           - Workers Compensation 62
- Facility/Institution 8                             - Other 59
- Patient Abuse 7                                    - False Claims 15
- Laboratory 6                                       - Misappropriation/Embezzlement 13
- Home Health 6                                      - Application Fraud 10
                                                     - Life Insurance 9
                                                     - Premium Fraud 7




                                                                                          141

				
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