Insurance fraud is no laughing matter, but the lengths that some crooks go to in their attempts to scam the industry often is.
Once again, the Coalition Against Insurance Fraud (CAIF) is unveiling its annual Insurance Fraud Hall of Shame. This year’s list-toppers include an x-rated romp, poisoned pudding, an ex-cat, and a slice-and-dice on a man named Porky.
“Consumers must be reminded that insurance fraud has victims. The Hall of Shame exposes the masters of disaster and true-life crime details for full public viewing. Sordid or silly, these stories work to convince more consumers that fraud is a dead-end street and freeway to jail," said Dennis Jay, the Coalition's executive director.
To read the full list of 2012's "best" scams, click the following pages.
The Case of the Ambitious Arsonists
Detroit firefighter Brian Baulch didn’t remember the bricks raining down on him amid the inferno of a blazing two-story office building.
He was knocked unconscious. The hail of debris broke his nose and both feet, six ribs, his pelvis and six vertebrae.
He was the lucky one.
Fellow firefighter Brendan Milewski was paralyzed. They were among seven injured firefighters trapped and injured in a fire set by Calvin Jones and a crony to steal insurance money.
But the arson scheme spun desperately out of control, also ruining three businesses in the building.
The duo spewed gasoline into the structure through a hole in a brick wall they’d created earlier in the day, then lit the volatile brew afterward.
Four of the seven were critically hurt; some firefighters required months of healing and rehab before they could return to work, and several will never work again.
A tipster turned in Jones and Wright afterward. Investigators soon found residue of gasoline in the wreckage—strong evidence of arson.
Wright intimidated him at gunpoint into going along with the plan, Jones argued at trial. He also was just a lackey for the owner of a Metro PCS store in the building, he claimed. The owner had hired them to torch the store for a $15,000 cut of the expected insurance payout, he said.
Jones showed little remorse when convicted, and insisted he didn’t get a fair trial. He was sentenced to 15 years in federal prison in December 2011, which just qualified him for this year’s Hall of Shame. Wright received 15 years in prison earlier last year. The storeowner’s fate has not been publicly announced.
The Case of the Helping Hand
Michael "Porky" Weaver only dimly grasped what David Player and Gerald “Trey” Hardin wanted to do: saw off his right hand for $671,000 in homeowners and disability insurance money.
The insurance scheme was a betrayal of what the Sumter County, S.C. man thought was a deep friendship with Player, who strung him along to set up the con.
Porky is severely mentally handicapped and illiterate. Player and Porky had grown up together, and Porky depended on Player for many of his personal needs and emotional support. Player even had Porky’s power of attorney.
That close tie was enough to convince Porky that the grisly insurance plot would work. The money would come from homeowner and disability policies Player had bought in Porky’s name.
Player and Hardin promised Porky a down payment on a truck and some rent money.
The three got drunk to prepare for the gruesome deed. Hardin, a tree trimmer, tied Weaver’s arm to a tree limb with rags. He sliced off Porky’s hand using a trimmer with a gas-powered, 8-inch chainsaw blade at the end of a pole.
Player wrapped a tourniquet around Porky’s arm and rushed him to the hospital. Doctors tried unsuccessfully to reattach Porky’s hand.
Player lied to the insurance companies that the wound was a tree-trimming accident.
The Hartford paid out $375,000 in homeowner insurance money and $296,000 from coverage for accidental death and dismemberment.
Player ended up with most of the money under his power of attorney. Porky received only enough to buy some beer and cigarettes, prosecutors said.
Player lived off the insurance money for several years and bought luxury goods. He also built an auto repair shop, and paid for his divorce. Another chunk of the money paid for the attorney he hired to engineer the insurance payouts.
The scheme began unraveling during Player’s divorce. His wife discovered a briefcase containing several dozen credit cards Player had taken out in Porky’s name. He’d used the credit cards to pay for the insurance. His wife handed over the cards to her lawyer, who went to the FBI.
And the wound was a gruesome giveaway to fraud, prosecutors argued at their trial. The cut would’ve been more ragged as he struggled with the buzzing saw in a real tree-trimming accident.
Porky’s helping hand netted Player 14 years in federal prison, and Hardin 3 years and five months.
The luckless Porky now wears a hook, and wasn’t prosecuted because of his mental disability.
The Case of the Decadent Sinus Doctor
Mark Weinberger had a nose for money.
His sinus practice lured hundreds of anxious patients seeking his supposedly healing touch. But instead of curing them, the Chicago-area man raked in millions of dollars with worthless surgeries.
Bogus insurance billings fueled much of Weinberger’s business.
The Ivy League-educated specialist advised nearly every patient he saw at their first appointment that they needed a sinus-related surgery. Sometimes he examined up to 100 patients a day—spending all of 3 minutes to diagnose them.
Weinberger did hundreds of false procedures, billing insurance companies up to $40,000 or more per patient. He also billed for procedures he never performed.
Weinberger drilled holes in the back of his patients’ sinuses, an outdated method that actually worsened the problems for many, inflicting chronic sinusitis they didn’t have before Weinberger treated them.
He stole $30 million of insurance in just 3 years, and lived a sultan’s lifestyle.
He drove from his Chicago home to work in a chauffeur-driven limo. He owned $2.4-million townhouse condo in Chicago.
A full staff, including a personal assistant and three maids, maintained his home. A masseuse gave him and his wife Michelle Kramer massages each night.
Weinberger also bought an 80-foot, $4 million motor yacht called the Corti-Seas.
But realizing the law finally was closing in, he set up his escape on a vacation.
Weinberger brought his wife Michelle and an entourage for a trip to the Greek islands aboard the Corti-Seas, which was docked in Mykanos. He suddenly disappeared one morning, leaving Michelle no explanation or money to get back home.
Weinberger evaded capture for 5 years, hiding in the Italian Alps. He cavorted with an Italian girlfriend for much of the time, but his life soon unraveled. Law enforcement found him shivering in a tent on a snowy mountainside 6,000 feet up in the Alps. His girlfriend had tipped off the police.
Various Indiana review panels found him negligent in at least 20 cases, and more cases are pending. So far, at least 350 angry patients have sued, and a judge sentenced Weinberger to 7 years in prison for insurance fraud.
The Case of the Bogus Airbags
Dai Zhensong flooded the U.S. with shoddy airbags forged inside his factory in China. His potentially deadly crime is “an extreme safety risk,” the federal government said in sending out an urgent national alert warning hundreds of thousands of drivers.
Crooked bodyshops that buy Zsensong’s airbags usually have a potentially deadly insurance crime in mind.
They install cheap or knockoff bags like Zsensong’s for a few dollars, then fraudulently charge insurers $1,000 or more for new replacement versions.
The danger is almost impossible for motorists to detect because the airbag is well-hidden inside its compartment. The con usually only surfaces in a crash, when airbags are needed the most.
Zhensong bought airbag systems made by legitimate car companies, then copied them at his factory. They were made of cheap and substandard materials, and poorly put together.
Zhensong then bought trademark emblems from Honda, Toyota, BMW, Audi and other dealerships in China, and fastened the emblems to the bags. He sold them on the Internet and black market for only $50 to $70 each. To untrained consumer eyes, his knockoffs could’ve been the real thing.
He sold potentially thousands of deadly airbags from his U.S. base in Chattanooga, Tenn.
Charlotte, N.C. body shop owner Igor Borodin sold about 7,000 of Zhensong’s counterfeit airbags on eBay for at least $1.4 million, federal officials say.
Investigators found another 1,514 airbags at Borodin’s home, ready for sale. Other fakes were found at his body shop, waiting to be installed in customer vehicles. The feds intercepted yet hundreds more bags being shipped to him.
The feds tested some of Zhensong’s airbags on crash dummies. Some bags didn’t inflate or inflated only partially.
Other bags sent out searing fireballs when inflated, or spewed sharp pieces of shrapnel at the crash dummies. A bolt lodged in one dummy’s forehead.
The fakes could involve as many as 250,000 vehicles, feds say.
Nursing assistant Damaris Gatihis died when she was rear-ended on a freeway outside of Seattle. Her car spun around and hit another vehicle head-on. Her airbag had been removed in a con separate from Zhensong’s.
Vehicles with airbags replaced in the past three years by a repair shop that isn’t part of a new car dealership may be at risk, the recent federal alert says. Drivers also may be in danger if they buy a used vehicle whose airbag had deployed before the purchase. Salvaged or rebuilt vehicles also could be risky.
The feds are urging consumers to contact call centers to see if they’re potentially affected.
Zhensong pleaded guilty and received 37 months in federal prison. Yorodin also pleaded guilty, and could spend the next 10 years in federal prison when sentenced.
The Case of the Former Feline
Yevgeny Samsonov was rear-ended at a traffic light when the other driver’s foot slipped off the brakes.
The Tacoma, Wash. man needed chiropractic treatment, and the driver’s insurer PEMCO paid nearly $3,500 to cover the bills for treating soft-tissue injuries.
But nothing could save his beloved cat Tom, who was in the car and somehow died in that little vehicle dustup.
At least that’s what Samsonov said after suddenly reappearing two years later. Tom’s life was worth something material, he told PEMCO.
The insurer sent Samsonov $50. But Samsonov said he’d paid $1,000 for Tom, who was like a son to him. He made a $20,000 claim. The insurer asked Samsonov to send images of Tom as proof. So he forwarded two images he said he’d taken of a handsome white cat with blue eyes.
A PEMCO employee did a simple search of Google images using the search term “white cat.” The same images appeared almost immediately. Samsonov’s images were of different cats, and neither was Tom. In fact one image was featured on the Wikipedia site devoted to cats.
The insurer cancelled the $50 check and sent the case over to the Washington State fraud bureau.
The unit investigated further, and officials confronted Samsonov with the evidence. He made several denials and kept changing his story, Assistant Attorney General Melanie Tratnik told reporters.
Samsonov was charged with insurance fraud and attempted theft. Samsonov faced up to a year in jail but was sentenced to 45 days, with 15 in jail and the rest under home monitoring. He also was fined $2,250.
The Case of the Frisky Janitor
Modupe Adunni Martin insisted her ankle injury was so painful that she couldn’t walk or do her job as a janitor at Woodside High School in San Mateo County, Calif.
She needed crutches just to get around. Martin convinced her employer and doctors that she deserved workers compensation money plus plenty of time off to heal.
What followed was an X-rated romp in the park that, well, exposed Martin’s plot. Her injury was phony. She stole tens of thousands of dollars of insurance money until her libido helped get her jailed for fraud.
After reporting her injury, Martin dutifully attended 10 doctor appointments to confirm she was still injured and needed more workers compensation money. Hobbling into the office on crutches, Martin was a convincing patient.
But suspicions arose that she was faking the injury. The district attorney’s insurance fraud unit set up video surveillance near the doctors’ office to confirm if her injury was real.
Martin was caught entering the doctor’s office on crutches but leaving on her own two feet. Martin then walked to her car, tossed her crutches into the back seat and drove to a nearby gas station. She put on high heels and literally ran into a nearby public park. There she met her boyfriend, then knelt and performed oral sex right in the park. A surveillance camera caught her entire performance.
That sex act was impossible for someone with her ankle injury, doctors concluded at her trial.
Martin was charged with 10 counts of insurance fraud, and pleaded no contest. She was convicted of workers compensation fraud, landed nine months in jail and was ordered to repay more than $79,000.
The Case of the Nightmare Nursing Homes
Hundreds of low-income seniors starved from malnutrition, and were surrounded by rodents and rotting garbage in George Houser’s nursing homes.
The Sandy Springs, Ga. raked in $32 million in bogus Medicare and Medicaid claims while providing virtually none of the services for which he billed taxpayers.
The Harvard-law grad spent more than $4.2 million in stolen insurance money on real estate for a hotel complex he planned to build.
Houser also treated his ex-wife to a $1.4-million house instead of paying her alimony, and paid his current wife salary as a nursing-home employee even though she never showed up.
All the while, residents lived on near-starvation food shortages. Houser didnʼt even pay food suppliers, pharmacy vendors, clinical labs, medical waste disposal, trash disposal or nursing supplies.
Roofs in two nursing homes leaked so badly that employees used barrels and plastic sheeting to catch and divert rainwater. Soaked ceiling panels tumbled onto residentsʼ beds.
Houser stopped paying for trash collection as well, and rotting garbage piled up around the Dumpsters.
Frustrated employees used their own money to buy groceries, nursing supplies and cleaning material. They also washed residentsʼ soiled clothing at their own homes or local laundromats.
Morris Ellison died of malnourishment, dehydration and an untreated broken hip, the medical examiner testified at Houser’s trial. Her daughter also sued him and earned a $43.5-million jury verdict.
Houser also stole health premiums heʼd taken from employee wages. Their health coverage thus lapsed for nonpayment. Their paychecks also bounced.
Many staffers were stuck with large medical bills for surgery and other medical treatment.
The court handed Houser 20 years in federal prison.
The Case of the Poisoned Pudding
Alan Duvall went to his maker peacefully, dying in a drug-induced stupor while slumped in a lawn chair on his estranged wife’s back patio.
He was separated from Tami, but had come over to fix an air conditioner. He drank a lot, then went outside to the chair and passed out, she said.
She found him the next morning and called 911, but he was dead, she said. The Indianapolis-area man died of alcohol poisoning, investigators first ruled. He had an inhumanly high alcohol content of .436 percent.
But the deeper investigators looked, the more proof they discovered that revealed a darker truth: Tami had poisoned Alan’s dessert pudding with huge doses of morphine and muscle relaxants for $100,000 in life-insurance money. She was sentenced to 60.5 years for murder, insurance fraud and other crimes in 2011. Her appeal was denied in 2012.
Tami wanted to divorce /alan, but still convinced him to buy the life-insurance policy only a month before he died. She was the beneficiary. She’d lied to him that it was a mortgage-insurance policy.
Alan’s blood contained massive amounts of medical drugs—82 times the maximum therapeutic level of morphine and 89 times the max for muscle relaxants.
Tami told investigators that Alan had poisoned himself because “he wasn’t willing to live if he couldn’t move back home and have free rein to do the things he wanted to do.”
The massive drug doses triggered a homicide investigation.
The morphine and muscle relaxants also were easy for Tami to obtain; she was a nurse’s aide at a local nursing home.
And Tami was anxious to have Alan’s body quickly cremated to cover up the evidence. She also kept asking officials when the investigation would end so she could collect her $100,000.
Tami's financial life was in shambles and she was having an affair with the insurance agent who issued the life policy. Tami needed Alan out of the way.
The agent advised her not to file a claim while investigations were underway. The claim would look suspicious, he said, but Tami rushed a claim into motion anyway.
A neighbor saw a large bottle of the muscle relaxant on a table inside her front door.
And Tami's former boyfriend Steve Brown testified that several years prior she arrived at his own home with a meal, including a pudding she insisted he eat. He took two bites and almost immediately felt dizzy. Tami also brought along a life-insurance policy. She urged Brown to sign it. He refused, so she left with the food.
The evidence took investigators and prosecutors 3 years to assemble. And the jury agreed: Tami fed Alan a wholesome dinner of fresh salad and vegetables. Next came his favorite desert called “dirt pudding,” a rich mix of Oreo cookies, vanilla instant pudding and whipped cream. Alan couldn't resist--and the dessert was the last he ever ate.