Medical Insurance Fraud - "Let Me Help You Up"

A man got more than monetary compensation when he filed claims for injuries from a fall in front of a Philadelphia check cashing business in 2007. He got arrested on criminal charges.

The insurance company investigators discovered the claim was fake when one witness said the man never fell. Further investigation revealed this was only the tip of the iceberg. They discovered that the man's attorney had filed a large number of false insurance claims on behalf of his clients over a 25 year period.

The attorney had recruited almost 100 people, called "runners," to help him find claimants and fake injuries for false insurance claims. What's more, he even gave instructions to these recruited clients to obtain medical care from multiple physicians and to seek more expensive medical treatment so the larger medical bills would generate greater insurance compensation.

Over the past 25 years, four runners alone were responsible for over 300 claims, generating over $2.5 million in payouts from insurance companies. The attorney, four of his runners, and 10 claimants were arrested and others have criminal charges pending.

Workers' Compensation - "Who did I pay insurance to?"

"Thomas Hurd, a former Bucks County insurance broker, was arrested in May after taking advantage of four insurance premium finance companies and the Commonwealth's Bureau of Unemployment Compensation out of a total of more than $1 million between 2001 and 2003."

Thomas Hurd owned his own insurance agency business, which acts as a middle-man between four premium finance companies and his clients. He sold insurances and acted as a broker to transportation companies. He asked these clients from the transportation businesses to follow his insurance policy. He would then collect all the insurance payments that were meant for the four premium finance companies and put them in his own pocket. After a period of time, the contracts with the finance companies were canceled because of unpaid premium, which left his clients uninsured.

In addition, Hurd fraudulently placed five of his employees on unemployment status to decrease his agency's wage expense. He only paid his employees partial wage in addition to the unemployment fund from the State government. By doing so, the employees got the same payment while Hurd saved lots of money because the Department of Unemployment Compensation paid part of his employee's salary.

Hurd received 11.5 to 23 month in prison and a consecutive seven years probation and court costs. In addition, he needs to pay back $1,019,757.98 to the four finance companies and the Department of Unemployment Compensation.

Property Insurance - "Please steal my computer"

A previous employee of a Delaware County pizza shop asked its owner George Zarganakis to pay his salary for past work. Since he was short on cash, George came up with a plan to earn some extra money. He asked this employee to break into his house and steal his Dell computer, and promised to pay him with the insurance compensation.

After the employee take the computer away, George reported it stolen and filed a claim not only for the computer, but some jewelry and cash. His insurance company paid him more than $8000 for what he claimed to be stolen. When the police started to investigate the theft, they overheard a tie which directed the Police to the employee who stole from George's house. The police began to put the real story together during the investigation. By getting a tip, the police talked to this employee, who told the police of the burglary plan without much effort. His claim was supported when the detectives found a voice message in the employee's cell phone from George saying that they needed to work on getting the story straight to deceive the investigators.

"George Zarganakis negotiated a guilty plea, and since then has served time in jail and was ordered to pay restitution".

Automobiles Insurance - "Who crashed into whom?"

While cruising along in their Harley Davidson, a man and his friend claimed that a mini-van swerved into them, causing them to crash into three parked cars.

After his face was cut by a truck mirror and his body hit the pavement, one man was badly injured. Instead of calling 911, his friend helped him onto his motorcycle and they arrived at the nearest hospital an hour later. The man later filed a claim to State Farm, which stated that he invested over $30,000 into his motorcycle in addition to the medical treatment.

His story was proven false by a young couple who witnessed the accident. They saw him driving at a high speed, losing control on his own, and crashing into three cars. The couple ran to help after this accident but the man's friend threatened them and told them to go away. The young couple called the police after getting the license plate numbers from both motorcycles. In addition, the investigation showed he had a Blood Alcohol Content of .074, which is over the legal limit. Sentence to this biker is pending.

Healthcare Insurance - "Attorney got sentenced"

A Texas attorney, Eric Amoako, was sentenced to prison in November 2008 because his participation in a life insurance fraud scheme.

From 2005 to 2006, Amoako was involved in a million dollar life insurance fraud case. The case involved paying brokerage to The Hartford Insurance Company claims adjuster for causing checks to be mailed to Amoako and others for services never rendered. Amoako received $236,711 in fraudulent insurance checks from Johnson, a Hartford employee who authorized payments from The Hartford to medical clinics Johnson sent a total of $1,717,737 in checks to four of her clients, including Amoako. Amoako has paid $65,000 in restitution to The Hartford.

Amoako was sentenced 18 months in federal prison to be followed by a three year term of supervised release. More seriously, he has voluntarily surrendered his Texas law license and is ineligible to practice law. (Case is from Insurance Journal website)

Other - "Are you really a lawyer?"

A man stole over $439,000 in total from over 38 clients by establishing phony law firms and pretending to be a lawyer in Philadelphia. The man was never licensed to practice law in Philadelphia, as the investigators found out later after a complaint from one of his clients, who said that he has never completed a service that he is hired to perform.

From 1999 to 2005, the man registered 6 companies, including 3 law firms in order to steal goods and services. At least 4 people paid him money for legal services that were never performed. For one case, he was hired by a grocery store owner to resolve an insurance claim. The store was crashed into by an uninsured driver. The fake lawyer convinced the owner to give the insurance payment to him so that he could use it to generate more insurance reward for the store owner. The owner ended up paying over $43,000 in retainer fees and insurance payments to the fake lawyer. However, the owner didn't receive any promised insurance reward.

In addition, the man opened fraudulent banks to generate bank deposits. He signed contracts with various companies for goods and services that he never paid for. "To do so, he used various fake and stolen identities, bad checks, and multiple credit card accounts secured with fraudulent businesses". In addition, he registered five cars with fake insurance information, which led these uninsured cars to operate on the road. He also registered two cars as ambulances for a phony ambulance service.

The sentence for this man is pending.

Works Cited

• Top 13 Insurance Fraud Cases of 2007: The Unlucky 13. (2007). Retrieved January 20, 2008,
  from Pennsylvania Insurance Fraud Prevention Authority: www.helpstopfraud.org