Doctors, agents, and an antique dealer defraud Pennsylvanian

An antiques dealer, an auto mechanic and even a couple of insurance agents are among the dishonored on 2005’s Top Ten Pennsylvania Insurance Fraud cases list, released by the Insurance Fraud Prevention Authority. This year’s list shows that the people who commit fraud come from many backgrounds.

Highlights from this year’s list include the Philadelphia man who collected $261,000 in damages from a house fire investigators said he set; a doctor who learned that getting busted can be a bitter pill to swallow; and a man who billed his insurance company for anti-aging treatments.

“We release this list each year to show Pennsylvanian that insurance fraud is not always committed by hardened criminals, but by average consumers often unaware they may be committing a felony that could land them in jail,” said Roy Miller, executive director of IFPA. “This list, as well as our newly designed website, informs individuals about different types of fraud; helping them stay on the right side of the law.”

The top cases for 2005 were:

#1: Double Agent
A former Canonsburg insurance agent was busted for allegedly pocketing more than $51,000 in premiums that elderly victims paid for long-term care and home health insurance. The agent is charged with 12 counts of theft by deception and 12 counts of theft by failure to make required disposition of funds received.

#2: Doctor’s Fraud Case Has a Ring to It
A well-known Lancaster City physician filed a fraudulent theft report and insurance claim during the 2004 holiday season. The doctor claimed that a diamond ring, appraised at $35,000, had been stolen from his car. He said he was planning to present the ring to his “wife” as a holiday gift. But authorities became suspicious when there was no sign of forced entry into the car, and later learned the doctor was unmarried. The doctor’s former girlfriend told police she had returned the ring to him. Police say the doctor became frustrated when he was unable to sell the ring for its appraised value.

#3 A Wrinkle in Anti-Aging Treatment
Thomas Bechard went to the Palm Springs Life Extension Institute for hormone therapy treatments to slow the aging process. Bechard signed a contract indicating he understood the treatment was not covered by any medical insurance. Yet when Bechard returned home to Pennsylvania, he submitted $17,000 worth of claims to Highmark Blue Shield using official insurance code numbers. Highmark later audited Bechard’s account. Interviews with Bechard revealed that he had purchased ICD-9 books before filing the claims to ensure he was using the relevant insurance codes.

#4: Filing was No Accident
A Delaware County man allegedly filed a workers’ compensation claim in 2001, stating he had sustained injuries to his lower back, right leg and neck as a result of a work-related injury. However, the man allegedly failed to report that he was treated for injuries to his neck as well as back pain after a 1998 car accident. The suspect’s employer’s insurer settled his workers’ compensation claim for $120,000 in lost wages and $52,000 in medical bills. The information about the 1998 car accident came out later. He is awaiting trial. If convicted, he faces seven years in prison and a $15,000 fine.

#5: Burning Down the House
A former Philadelphia-area antiques dealer found himself in hot water when investigators found inconsistencies after a fire ravaged his home. Authorities held Steven J. Menasion of Nottingham on charges of arson and insurance fraud. His insurance company, which paid Menasion $261,000 after fire, found that the destroyed items detailed in Menasion’s insurance claim did not match with the charred remains at his home. For example, screws, nails or bolts from the $3,000 dining room set would have survived the blaze, and $700 worth of pots and pans would not have vanished without a trace, police said. Menasion is now in prison.

#6: Scam Runs Out of Gas
A Prospect Park auto mechanic thought he was going to make some money on the unseasonably warm afternoon of Feb. 24. The owner of E-Z Auto Repair on Lincoln Avenue, he had found a buyer for his Snap-On Modus Elite, a diagnostic computer used to repair cars. The problem was, the perpetrator had reported that same computer and other tools had been stolen from his shop in an Oct. 1 burglary. In fact, he had filed an insurance claim and was paid $18,570.30 by Mid-Continent Insurance Company. He didn’t know that the man he had arranged to meet outside his shop that day was an undercover detective from the Delaware County Criminal Investigation Division.

#7: Bad Medicine
A Center City physician was charged March 23 in federal court with trafficking in thousands of Percocet and OxyContin pills, and with $104,000 worth of health-care fraud. Assistant U.S. Attorney Amy Kurland charged the doctor was with illegally selling nearly 3,500 Percocet pills and more than 2,360 OxyContin pills between October 2003 and June 2004. The doctor allegedly sold the drugs “without a legitimate medical purpose and outside the usual course of professional practice” and defrauded several insurers, including Independence Blue Cross, Aetna U.S. Healthcare, HealthNet, Keystone and Americhoice by filing claims for some of the drugs, which were valued at more than $104,000.

#8: The Name Game
Between April 2002 and July 2003, a woman was admitted to Thomas Jefferson University Hospital on six occasions for various medical treatments, including two surgical procedures. In five of the six admissions, she allegedly presented an Independence Blue Cross medical card belonging to a man and identified herself as his ex-wife, who was still covered under his insurance policy. The hospital billed more than $49,000 for services, of which Independence Blue Cross paid $3,000 before uncovering the fraud. The woman later admitted she had a relationship with the man and he had given her his ex-wife’s card.

#9: Customer Disservice
A Bucks County insurance agent has been charged in connection with various scams after allegedly tampering with one of his client’s insurance policies and stealing $127,233 of her money. According to the charges, in 1999, the client gave the agent $25,000 for the policy, but the agent allegedly pocketed the money. Four years later, the charges allege, the agent submitted a fraudulent withdrawal form to the insurance company, requesting $53,139 from a policy owned by the client. The agent allegedly forged the client’s signature, had the check for $53,139 sent to his P.O. box and then forged the client’s signature on the check.

#10: There’s No Such Thing as a Free Ride
Johnny Bush learned the hard way that living off of insurance companies doesn’t pay. Bush’s troubles began after an auto accident on June 22, 2002. While damages to his car were negligible, Bush alleged that he injured his shoulder and he claimed lost prospective wages. Bush claimed he was just about to start a new job at Corporate Bank Transit. Progressive Insurance Company investigators learned Bush “lived off of insurance companies;” had numerous claims against various companies over the years; and had just settled a claim concerning a back injury. Bush’s brother, the manager of Corporate Bank Transit, had written a letter at Bush’s request stating that Bush was going to start a job there but later came to suspect his brother was up to something. Bush’s brother testified before the jury, which convicted him. He was sentenced to 6 to 12 months in prison and four years consecutive probation.