A Buffalo contractor faces felony fraud charges for allegations that he worked as a roofer while receiving workers compensation benefits.
According to Buffalo Business First, the owner of Independent Contractors Inc. was taken into custody last month, charged with offering a false instrument for filing, grand larceny and insurance fraud.
According to a press release from the New York State Insurance Fund, he allegedly hid work as a roofer from the state.
Investigators from the Division of Confidential Investigations said the man applied for workers comp insurance as a siding contractor. But after one of his employees filed another claim with NYSIF in a fall from a roof, the investigation revealed Independent Contractors has allegedly done roofing work since 2007.
The owner allegedly defrauded NYSIF of more than $3,400 during that time to pay a lower premium as a siding company for his workers comp insurance
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Two Burbank, Calif. brothers face a total of 600 years in prison if convicted of defrauding at least $300,000 from a workers compensation program for injured post office workers.
Authorities say the brothers pleaded not guilty Nov. 8 to charges contained in a 30-count indictment alleging wire fraud. Their trial is scheduled for December. (WCxKit)
Each count of wire fraud carries a maximum sentence of 20 years in federal prison, according to the U.S. Attorney's Office.
The brothers are charged with submitting bills for transporting injured Postal Service employees to non- existent medical appointments.
Investigators claim the brothers operated a pair of Los Angeles-based transportation companies, A&R Medical Transportation and V&Y Management Inc., doing business as Prestige Transportation.
The indictment also alleges they "grossly inflated" the amount of their claims to the Department of Labor's Office of Workers Compensation and private insurers.
Total losses are at least $300,000, according to the indictment. (WCxKit)
The brothers were taken into custody Oct. 20. They remain free after posting $75,000 bond each, according to officials.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The Ohio Bureau of Workers Compensation (BWC) Board of Directors recently received a report on the performance of employer programs.
The report was presented to the Boards Actuarial Committee, and focused on new programs developed over the past few years to help employers reduce their premium costs, as well as the agencys largest cost-saving program, the group-experience rating program. (WCxKit)
According to the report, the number of employers participating in Group Rating remained stable from 2009 (97,604) to 2010 (96,575). It also concludes group participation has not been impacted by reductions in the maximum credibility discount as the number of employers participating at the maximum level remained constant from 2009 to 2010.
“Continual review and evaluation are crucial to understanding the impacts of the changes to the Group Rating program,” said BWC Administrator Marsha Ryan. “We are pleased with our progress in eliminating the extreme imbalance in what group-rated and non group-rated employers were paying for the same workers compensation insurance coverage, while maintaining incentive for employer participation in Group as well as other BWC program offerings.”
The Board also approved the agencys Fiscal Year 2010 Annual Report, which is published jointly with the Industrial Commission of Ohio. The report will be submitted to Gov. Ted Strickland and legislative leadership, and covers the period from July 1, 2009 to June 30, 2010.
In FY10, BWC managed 1.2 million open claims and paid medical and indemnity compensation to injured workers totaling nearly $1.9 billion. (WCxKit)
Other highlights include the identification by BWCs special investigations department of more than $66 million in workers comp fraud, representing $6.30 in fraud identified for every dollar spent; and the devotion of 96 cents of every premium dollar collected to the care of injured workers, compared with the U.S. average of 69 cents.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com
A Schenectady man was sentenced in federal court to pay over $20,000 in restitution and five years probation for lying in order to obtain workers compensation, federal prosecutors announced. (WCxKit)
The individual admitted in April to receiving federal workers comp benefits he was not entitled to.
The man filed for benefits following an injury while he was a safety technician for the Transportation Security Administration at Albany International Airport in July 2004, and he collected benefits from September 2004 through August 2009. He was required to file certifications indicating he was not employed and that he had no stake in any business. (WCxKit)
But evidence obtained by the government confirmed he was working at an auto repair business he purchased in May 2009 from Spring 2008 through August 2009 prosecutors said.
The benefits amounted to over $1,000 a month. He will be required to pay back $21,897.98 for the period from April 2008 through August 1, 2009.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
FREE TOOLS
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Possible Causal Relationships Considerations
Have you ever read a court decision on a workers' compensation case and had the reaction……. “what?” The following discussion of a court decision definitely creates a “what?” reaction in most people. A press release explained how the Wyoming Supreme Court overturned a lower court decision denying medical benefits to a man who claimed a spinal cord stimulator caused a hernia.
In 1993 James L. Ball slipped while walking into a walk-in refrigerator to get some milk. Mr. Ball claimed injury to shoulder, neck, back and right leg. He was awarded permanent total disability.
What? Yes – Permanent total disability for a foot slipping. The court description of the accident does not indicate Mr. Ball fell when he slipped.
(WcxKit)
Wyoming is a monopolistic state for workers compensation. You have to wonder if the state employee/work comp adjuster was asleep at the wheel on this one. The location of the accident in the walk-in refrigerator makes it most likely an unwitnessed event. There is no mention in the press release if Mr. Ball's accident was witnessed or if any investigation was done to confirm how Mr. Ball's foot slipping would have injured his shoulder, neck or back. A strain to the right leg is possible. As Mr. Ball had a spinal cord stimulator implanted in 2000, he definitely had an injury, but did the injury happen on the job? Anyway, the claim was accepted.
In 2006 the original spinal cord stimulator failed and a new one was implanted. In 2007, Mr. Ball states he was at home lying in bed when the second spinal cord stimulator caused him to experience a sensation that made him to stand up “real fast” then he fell down, causing a pain in the groin. [Another unwitnessed event?]. Ball went to a Dr. James Shaw who ordered a CT scan that confirmed an inguinal hernia.
Dr. Shaw stated: I would consider this a work-related problem based off the origin of the fall.”
What? Inguinal hernia's are normally caused (according to the medical book) by a:
1). defect at birth,
2). prolonged wear and tear from lifting, straining or coughing,
3). age related weakness of the abdominal wall,
4). history of previous surgery in the area.
Risk factors increasing the chances of the hernia developing include advancing age, straining to urinate or pass stools, severe or prolonged coughing and obesity. Mr. Ball's description of how the hernia occurred does not fit the medical literature. In rare cases a hernia can be caused by falling hard on a blunt object, but there is nothing in the press release that states Ball fell on any blunt object. While Ball clalimed the spinal cord stimulator malfunctioned, there is no mention in the press release stating it was ever confirmed the stimulator malfunctioned. If the spinal cord stimulator malfunctioned as claimed, there is no mention of Ball bringing a products liability claim against the spinal cord manufacturer. What? You have to wonder why no products liability suit was brought if the spinal cord stimulator did malfunction.
The Wyoming Division of Workers Safety and Compensation denied payment for the hernia treatment on the basis it was not related to the original 1993 injury. There is no mention in the press release whether or not the state employee/work comp adjuster had an independent medical examination done to refute the doctor's statement. Also, there is no mention in the press release whether or not the Division of Workers' Safety and Compensation did any investigation to determine if Ball was working somewhere else when the hernia occurred. What? You have to wonder why there was no investigation into other causes for the hernia.
Mr. Ball disputed the Division of Workers Safety and Compensation determination. The matter was referred for a contested hearing. At the hearing Ball contended he was entitled to medical benefits for the cost of the hernia treatment claiming the hernia in 2007 was causally related to the 1993 injury. The hearing examiner ruled in Ball's favor stating the hernia was caused by a fall, the fall was caused by the spinal cord stimulator, the spinal cord stimulator was implanted to treat Ball's chronic back pain.
The adverse finding for the Division resulted in their appealing the matter to the District Court. The District Court found the examiner was correct in its finding of fact, but ruled against Ball stating a hernia is a compensable injury only when it is the original injury. The District Court considered the hernia a second compensable injury which was barred. Ball appealed the District Court decision to the Wyoming Supreme Court.
The Supreme Court reviewed the work comp claim on whether the hernia occurred “in the course of employment” per the Wyoming work comp statutes. The Supreme Court ruled the position of Ball was in keeping with the language and context of the statute and with the legislative intent. Ball therefore received the medical benefits for the hernia.
Almost all states treat injuries that result from the original work comp injury as part of the original injury. For example: The employee had a verified work-related fall that caused a leg fracture. A week later the employee is on new crutches on his way to the doctor's office for his leg fracture, when he loses his balance. He falls and breaks his arm. The broken arm is causally related to the fractured leg. In most jurisdictions this is referred to as a “compensable consequence of the injury.”
In a similar vein, in a very recent New York case, a Cornell University employee, James Smith, had a compensable work-related back injury in 2001. Smith suffered depression that was brought on by the chronic pain related to the back injury. In 2007 Smith committed suicide. The New York State Appellate Court found “sufficient causal relationship” between the suicide, the depression, the chronic pain and the original work comp injury. The court has ruled Ms. Smith is now entitled to death benefits under the New York work comp law.(WcxKitz)
Causal relationships can be tricky. There needs to be in-depth investigation into any possible intervening events that would sever the causal link between the initial injury and the subsequent injury. If the employee can prove that the second event would not have occurred except for the original event (accident), the medical cost and associated indemnity disability cost will be owed by the work comp insurer.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.Contact: RShafer@ReduceYourWorkersComp.com
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
Employers as well as employees have been known to commit workers compensation fraud…
The owner of a New York pizzeria
who employed three people off the books was arrested for workers compensation fraud, according to the New York State Insurance Department.
The man is accused of knowingly submitting false documentation to the New York State Workers Compensation Board stating he had no employees so he could avoid paying workers comp insurance. (WCxKit)
Investigators from the Insurance Department's Frauds Bureau and the Office of the Fraud Inspector General of the Workers Compensation Board discovered he actually employs two people who work inside the pizzeria and a delivery person.
The individual could be sentenced to up to four years in prison if he is convicted. He is charged with workers comp fraud and offering a false instrument for filing.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
As an employer, you must be vigilant in your efforts to protect your company from the few employees who do commit workers compensation fraud. Adjusters often refer to possible fraud in a workers comp claim as looking for “red flags.” A “red flag” is anything standing out from the ordinary.
Any one of the items on the following list of “red flag” do not prove a workers comp claim is fraudulent. However, if you have several “red flag” on a single claim, it’s a good idea to consult with both the adjuster and the SIU unit about the claim. (WCxKit)
More Common and Less Common
Fraud
“red flags” employees intent on committing fraud may use:
1. Late Reporting
a. If an employee is really injured on the job, it is unlikely the employee will wait days or weeks to report the injury.
2. Accident Details
a. The accident details are sketchy, vague or fuzzy.
b. The employee has difficulty in recalling what happened.
c. The employee changes the description of the accident when inconsistencies are pointed out.
d. The nature of the injury is not consistent with the nature of the work done by the employee.
e. The date, time and location of the accident is unknown or forgotten.
f. The accident details are inconsistent with the employee job duties.
3. More Than One Version of the Accident
a. The employee gives completely different versions of the accident to the employer and the adjuster and to the doctor.
b. The employee keeps modifying the story of what happened.
c. The employee leaves out pertinent information.
d. The accidents details vary from medical report to medical report.
4. Witnesses
a. There are no witnesses to the accident and the employee normally works around other people.
b. There are witnesses but their version of the accident differs from the employee's version of the accident.
c. The accident occurs at a location away from where the employee would normally be working.
d. The nature of the injury is unusual for the employee's line of work.
e. The employee's co-workers express doubt that the accident occurred.
5. Unhappy Employee
a. The employee is disgruntled about some aspect of his/her job requirements.
b. The employee was demoted or passed over for a promotion.
c. The employee is on the list to be laid-off.
d. The employee is on “positive improvement needed” status and is about to be terminated.
e. The employee has had numerous prior employers.
f. The “accident” occurs immediately prior to a strike, plant closing or the end of seasonal employment.
g. The employee is a new hire.
6. Monday Morning Claims
a. The employee has an early Monday morning accident before the supervisor or other employees see him on the job (accident occurred off the job over the weekend).
7. Injured Worker is Never at Home
a. The injured employee is not at home during the normal workday.
b. The employee is always sleeping when the adjuster calls or cannot be disturbed.
c. The employee's family member is vague or noncommittal about when you can reach the employee.
d. The employee is “away” but quickly returns all calls from a cell phone, not the home phone.
e. The employee uses the address of friends or family members and has no definite address or uses a Post Office box as an address.
f. The spouse or other family members do not know about the workers comp injury.
8. Financial Reasons
a. The employee's spouse is not working and drawing workers comp indemnity benefits, social security disability payments, welfare or unemployment insurance and the employee wants the same life style.
b. The employee inquires about a settlement early in the claim process.
c. The employee was having prior financial problems.
d. The employee is nearing retirement age.
e. The employee files for benefits in a state other than where the accident occurred.
f. In the states where an employee can collect workers comp indemnity benefits based on the amount of combined wages from both the workers comp employer and a second job employe.
g. The failure to report other work income while drawing indemnity benefits.
h. The employee took excessive time off just prior to the injury.
i. The employee is in the middle of a divorce or other family disturbance.
j. The social security number used by the employee belongs to someone else.
k. The employee applies for Social Security benefits before the injury occurs.
l. Income from workers comp, disability or other sources exceeds the employees prior after tax income.
9. Medical Care
a. All the injuries are subjective — pain without trauma, soft-tissue, emotional.
b. The employee changes doctors frequently “doctor shopping” or changes doctors when released to return to work.
c. The employee has excessive treatment for soft-tissue injuries.
d. The medical treatment reported by the employee is different from the medical care stated in the medical reports.
e. The nature of the medical treatment changes from one body part to another after the employee has been treating for a while.
f. The employee misses medical appointments.
g. The employee fails to show up for an independent medical examination.
h. The employee refuses or delays diagnostic testing.
i. Whiteouts, corrections, erasures on medical forms submitted by the employee.
j. Exaggerated pain symptoms.
k. The employee has a history of multiple workers comp claims and/or reporting subjective claims of injury.
l. The injury relates to a preexisting medical condition or health problem.
m. The medical reports provided by the employee appear to be second or third times photocopied.
n. The length of recovery is excessive for the nature of the injury.
10. Inconsistent Physical Ability
a. The employee who has been off work for a while has calluses on hands or grime under the fingernails
b. The medical reports reflect “muscular” “tanned” or other adjectives to reflect the employee is in good health.
c. The employee is unable to work due to the injury but is seen painting his/her house, mowing the lawn, carrying heavy objects, etc. (WCxKit)
d. The employee has a high-risk hobby or does other physical exertion activities.
e. Surveillance reflects physical activity greater than what is reflected in the medical reports.
f. You learn the employee is working elsewhere while drawing indemnity benefits, especially where the work requirements exceed the capabilities reflected in the employee’s medical reports.
11. Miscellaneous Red Flags
a. The employee is unusually pushy to settle the workers comp claim
b. The employee has extensive medical knowledge but no training in the medical field, or has extensive insurance terminology but no work experience in the insurance field.
c. The employee was referred by a friend who name he does not know to a particular doctor or attorney.
d. The employee is a part of a group of employees using the same doctor and the same attorney for their workers comp injuries.
e. The attorney's letter of representation is the same day of the injury or even dated before the “injury.”
Summary: Remember, even if the employee's claim has every one of these “red flag,” it still does not prove fraud. However, if the work claim has more than one of these “red flag,” you definitely want to bring in a fraud investigator to delve deeper into the claim. The more fraudulent claims you identify and deny, the lower your overall cost will be for workers compensation insurance.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing.
Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
When employees file fraudulent workers compensation claims, not only are they stealing from the insurance company, but also indirectly they are stealing from their employer, the shareholders of the employer if a publicly held company, and from their co-workers. The fraudulent workers comp claim is included in the claim history used by the insurance company to set the premium rates for the employer. When the employer pays higher insurance cost due to fraud, there is less money available to invest in the company and to pay the wages and pay raises of the employees of the company.
Nearly 25% of workers comp claims involve some element of fraud, whether it is an outright bogus claim or inflation of an otherwise legitimate claim. The Coalition Against Insurance Fraud estimates workers compensation fraud cost employers $6 billion a year. The National Insurance Crime Bureau recently reported the number of suspicious or questionable claims has increased as the economy has deteriorated. In fact, workers comp fraud is the second largest category of white-collar fraud only behind income tax evasion. Every employer must be vigilant in protecting themselves from the dishonest employees who will attempt to exploit the workers comp claim system. (WCxKit)
There are five common areas of employee workers comp fraud:
1. The total bogus injury. The employee claims a hurt back or neck or other muscle problems for the sole purpose of collecting indemnity benefits.
2. The inflated injury. The employee receives a real job related injury but then tries to extend his/her time off work by pretending the injury is worse than it really is so s/he can collect indemnity benefits.
3. The prior injury. The employee has a real back, shoulder or knee problem from years ago, but now needs additional medical treatment for it.
4. The at-home injury. The employee gets hurt at home, working for someone else or participating in a sports event, and claims s/he got hurt on the job.
5. The malinger. The employee got hurt, got well, but got use to staying home and does not want to come back to work.
There are several courses of action the employer can take to combat workers comp claim fraud. One of the most effective things an employer can do reduce workers comp claim fraud is to have a well publicized and well used transitional duty or light duty return to work program. While a return to work program will not prevent all fraudulent workers comp claims, it will stop many of them.
The dishonest employee who got hurt at home but does not have medical insurance, or has medical insurance with a high deductible, will still file the fraudulent claim that he got hurt at work. However, the dishonest employee who wants to take an extended paid vacation with workers comp indemnity benefits, or the dishonest employee who wants to work at another job while collecting workers comp benefits, will be stopped from doing so by a strong transitional duty program.
In addition to a strong transitional duty program, there are various other steps the employer can take to fight fraudulent claims including:
1. Do not hire employees of questionable character or background. Prior to any offer of employment, thoroughly check the references of the potential employee and their background information.
2. If an employee refuses transitional duty work, or tries transitional duty work for an hour or two, or a day or two and then stops, make an immediate inquiry into what part of the transitional duty job can’t be done. Make arrangements to alter the transitional duty job to fit the complaints. If the employee still refuses the transitional duty work, ask the insurer's claims office to consider surveillance on the employee to be sure the limitations away from work are the same as when at work.
3. Keep an ear open to the rumor mill. Disgruntled employees are far more likely to file a fraudulent workers comp claim then happy employees. Address any legitimate grips or complaints of the employees.
4. Train your supervisors and department managers to recognize the characteristics of claims frequently indicating fraud. Provide the supervisors and department managers with a copy of our blog on Employee Workers Compensation Fraud
5. Make sure all new and current employees are aware of your fraud policy of prosecuting workers comp fraud as a criminal offense. (And back it up! If you have an employee who commits workers comp fraud be sure to fully prosecute. If you want to see the number of your workers comp claims skyrocket, feel sorry for the employee or his family and not prosecute an obviously fraudulent claim).
6. Make sure all employees understand that fraudulent claims come out of the employer’s pocket and reduce the pay raises or bonuses for everyone.
7. When you suspect a workers comp claim may be fraudulent or when you have rumors or evidence that a claim has an element of fraud, contact the workers comp insurer's Special Investigative Unit. They have the expertise and the connections with law enforcement to properly investigate and build the necessary proof to prosecute the fraud.
8. Make it a requirement that the claims handling office of the insurer or third party administrator files an Insurance Services Office index report on every new workers comp claim and does a claims inquiry every six months as long as a claim remains open.
9. Do not make it easy for the employee to file a bogus claim by having a lax safety program. By removing safety hazards from the work place, the employee has fewer options in creating a false injury scenario.
10. Remember many fraudulent claims start out with a real injury. When the employee sees the television commercial with somebody holding fists full of money that attorney so-and-so got them for their workers comp injury, the employee may be tempted to exaggerate his/her own claim. Anytime an employee hires a television attorney, you cannot discuss the claim with the employee, but you can advise the employee of the company’s policy to fight all claims vigorously when an attorney is hired. (WCxKit)
11. Make it a practice to reward fraud tips. Have a publicized program of paying a reward to anyone who reports a workers comp fraud resulting in conviction.
Fighting fraudulent workers comp claims is not easy, but it is absolutely necessary to protect your company's bottom line. Make fraud prevention a component of your integrated workers compensation program.
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com or 860-553-6604
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
A Memphis businessman was recently indicted on criminal fraud charges of underreporting his payroll for his labor subcontracting companies to deprive insurance companies of more than $1 million in workers compensation premiums.
The individual reportedly had a suitcase packed and was preparing to leave town when authorities took him into custody. (WCxKit)
The man is the owner of Xpress Services, Express Services, Labor Fast, Fast Track Systems and CSI Services, Inc. The companies provide workers for a variety of construction jobs, mostly for drywall work.
Authorities report the man had some 110 employees, but only claiming having half that many and paid no workers comp on the others. The alleged offenses occurred between January 2006 and July of this year. (WCxKit)
He was indicted on four state counts of workers comp fraud over $60,000, felonies that carry up to 12 years behind bars on each count.
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: Info@ReduceYourWorkersComp.com or 860-553-6604.
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
The ring leader in workers compensation insurance fraud scheme that defrauded two insurance companies out of more than $1.4 million was sentenced to 12 years in state prison, the California Franchise Tax Board (FTB) announced (WCxKit).
Rene Montes, 42, of Riverside, pleaded guilty June 7, 2010, to 122 felony counts including 59 counts of grand theft, 59 counts of insurance fraud, three counts of state income tax evasion, and one felony count of conspiracy, with sentencing enhancements allegations for aggravated white collar crime for loss over $1.5 million and $500,000.
In addition to 12 years in state prison, Montes was ordered to pay more than $1.7 million in restitution with more than $286,000 ordered for FTB for failing to file and report almost $1.5 million in income relating to the insurance fraud during the years 2004, 2005 and 2006.
Montes, doing business as W.C. Surgery Center, falsely represented to insurance companies he had authority to negotiate liens with them on behalf of medical providers. Information relating to the claims was obtained by Rene Montes through three contacts who worked at the insurance companies. The three co-defendants, Hector Porrata, 46, Moreno Valley, George Martinez, 44, Apple Valley, and Cara Cruz-Thompson, 47, Victorville, pleaded guilty May 7, 2010.
Porrata pleaded guilty to 50 felony counts of grand theft, 50 felony counts of insurance fraud, and 1 felony count of conspiracy. He was sentenced to eight years in state prison and ordered to pay more than $1 million in restitution.
Martinez pleaded guilty to 11 felony counts of grand theft, 11 felony counts of insurance fraud, and one felony count of conspiracy. He was sentenced to two years in state prison and ordered to pay more than $300,000 in restitution. (WCxKit)
Cruz-Thompson pleaded guilty to 12 felony counts of grand theft, 12 felony counts of insurance fraud, and one felony count of conspiracy. She was sentenced to two years in state prison and ordered to pay more than $200,000 in restitution
Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. Contact: RShafer@ReduceYourWorkersComp.com
©2010 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.
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