Volume 3, Number 3, October 1996
IFB News Briefs!


A Message from Edwin Rinehimer, Chairman, IFB Board of Governors

As we celebrate the fifth anniversary of the formation of the Insurance Fraud Bureau (IFB), it's gratifying to survey what we have accomplished. Our statistics are impressive (300 plus prosecutions, some still in process, 164 convictions, millions of dollars recovered). Our deterrent effect (unmeasurable, but reflected in improved claim experience and reduced insurance rates) is widely acknowledged. But perhaps most important is the new paradigm we've established in our joint industry-public sector endeavor.

Most obviously, the synergy between the IFB and Attorney General Scott Harshbarger's office has brought fraud fighting to a new level. Somewhat less visible, but equally important, is our governance. With the combination of representatives from workers' compensation and automobile insurers with the Commissioner of Insurance, Director of Labor, Secretary of Public Safety, Registrar of Motor Vehicles, Commissioner of the Department of Industrial Accidents, insurance agents and representatives from organized labor, we have an unprecedented coalition with which to address a pervasive societal issue. We must challenge ourselves to find expanded ways in which to leverage our relationships for the public good. As we move forward to our next five years, we must avoid complacency. Our initial success, while a justifiable source of pride, will increase the challenges we face.

First, we have established a high level of expectation. The numbers and kinds of cases handled and the professionalism demonstrated have earned the respect of the Federal Bureau of Investigation, the U.S. Attorney's Office, and a host of other local, state and federal agencies. We can expect future requests for involvement with many of these organizations. "Bad guys" are on notice as to how effective we can be. This is good news, on the one hand, as it has a deterrent effect. On the other hand, those still in the game are being more careful; the fraud perpetrated, more subtle.

The study by Richard Derrig and Herbert Weisberg released in July of this year demonstrated a significant reduction in the number of claims with obvious fraud (e.g. arranged accidents, "jump-ins", paper vehicles) but a marked increase in claim build up and fraudulent treatment and billing. These cases are much more difficult to prove and more expensive to litigate. They require that we continue to find innovative investigative and litigation strategies.

All of us involved in the fight against fraud have earned a moment of mutual appreciation. But there is still a great deal of work to be done. I'm looking forward to it.

Edwin J. Rinehimer
Chairman, IFB Board of Governors


IFB Progress Report
(through October 23, 1996)
Convictions 164
Individuals Indicted 146
Complaints Issued 192
Cases Referred for Prosecution 333


Attorney General Scott Harshbarger and the Insurance Fraud Bureau of Massachusetts invite you to attend a seminar on the Investigation of Automobile Glass and Body Shops

November 8, 1996; 8:00 a.m. - 4:00 p.m.
$30.00 per person
Holiday Inn, Taunton, Massachusetts

Agenda includes:

REGISTRATION MUST BE RECEIVED BY OCTOBER 30, 1996

For additional information, please call Deborah Terry, (617) 439-0439.


PREMIUM AVOIDANCE HIGHLIGHTS

"Scheme to Save Over $637,000 Ends in Conviction" Case Update

NEW HAMPSHIRE- The president of a New Hampshire temporary work service company intentionally misclassified employees as independent contractors rather than employees of his company. The misclassification allowed him to avoid paying $211,201 in employer taxes over a three year period. In addition, the subject provided Liberty Mutual Insurance Company with false information on the number of actual people he employed, thereby evading $426,463 in workers' compensation premiums.

Michael Bardzick, president of Golden Labor Service, Inc., pled no contest in Middlesex Superior Court on April 2, 1996. He was sentenced to serve 30 days in the House of Correction and ordered to pay $53,000 restitution to the Department of Employment & Training for six DET tax counts. He was sentenced to 3-5 years in MCI-Cedar Junction, suspended, and ordered to pay $91,000 to Liberty Mutual for two workers' compensation premium evasion felony counts. Assistant Attorney General Joshua Krell prosecuted the case with assistance from Investigator Edward Regan of Attorney General Harshbarger's Office.

"Framingham Contractor Cheats for $1 Million" Case Update

FRAMINGHAM- A Framingham contractor hired workers for five public works projects but neglected to classify the workers as company employees. As a result, the company avoided paying almost $1 million in workers' compensation premiums and unemployment taxes.

Eastern Contractors pled no contest to a charge of avoiding workers' compensation insurance premiums in Middlesex Superior Court on May 24, 1996. The company was ordered to pay $300,000 in restitution to ITT Hartford for back premiums and to pay $102,000 in restitution for back wages, unemployment taxes and costs. As a condition of probation, Eastern was prohibited from bidding on any public works projects for three months. Its subsidiary, East Coast Construction, pled guilty to one count each of failing to pay overtime wages, failing to pay the prevailing wage rate and failing to maintain true and accurate payroll records. East Coast was fined $4,000 and debarred from public works projects for six months. Assistant Attorneys General John Ciardi and Bruce Trager prosecuted the case.

All in the Family

CHICOPEE- The owner of an excavating and trucking company repeatedly told his employees to consult their own physicians if they were injured on the job and he would pay their medical expenses. The owner requested that they not file claims if injured because it would increase his workers= compensation rate. During the construction of a housing project for elderly residents, the owner did pay the medical bills for several employees who suffered work-related injuries. In another aspect of the case, his wife, the office manager of the company, informed Aetna Insurance that her father-in-law was working in a position that was in a lower job classification than the actual job he was performing for the company.

Complaints were issued against a Chicopee excavating/trucking company, its owner and the office manager on a total of 26 counts of insurance fraud-related allegations in Worcester District Court on May 16, 1996. The case is being prosecuted by AAG Bruce Trager.

Fraudulent Certificates Exchanged for W/C Coverage

BOSTON- A Quincy man allegedly conceived a fraudulent scheme to assist various courier/messenger companies to avoid paying workers' compensation insurance premiums by providing them with forged insurance certificates. The subject convinced owners of the courier/messenger companies that if their employees would join the subject's company, employers could obtain workers' compensation insurance certificates free of charge for their employees. The certificates are allegedly worthless and forged by the subject himself. The employees were each charged approximately $200 per year in dues by the subject company.

A Quincy man was indicted in U.S. District Court on eight counts of mail fraud and seven counts of wire fraud on August 1, 1996. The case is being prosecuted by Assistant U.S. Attorney Paul Levenson of the Office of United States Attorney Donald Stern.

Payroll Discrepancy Saves $60,000

BROCKTON- An Everett corporation, certified by the State Office of Minority and Women's Business Assistance, allegedly employed union workers on asbestos removal and demolition construction projects during 1993 and 1994. They were allegedly provided with workers' compensation coverage through ITT Hartford. The owner/president of the corporation allegedly distorted payroll amounts for these two years when she reported the totals to the carrier's auditor for calculation of the premium payment. The owner reported approximately $145,000 in payroll for the two years combined. It is alleged that the payroll amounts actually totalled over $775,000 for the two years. The alleged discrepancy saved the company more than $60,000 in additional insurance premiums.

An Everett company and its owner/president were indicted on charges of larceny and workers' compensation fraud in Norfolk Superior Court on October 2, 1996. Assistant Attorney General Molly Parks is prosecuting the case. She is assisted by Investigator John Crimmins of the AG's Public Protection Bureau.


HEALTH HIGHLIGHTS

"Podiatrist Practices Fancy Footwork" Case Update

MANSFIELD- A Mansfield podiatrist submitted fraudulent billing statements for services not rendered and false health insurance claim forms to Mega Life, Prudential, Travelers and John Hancock Insurance Companies. The doctor also inflated the number of procedures performed on actual dates of service for patients he did treat at his office.

On April 16, 1996 Joel Korins pled guilty to insurance fraud, larceny, filing false health care claims and conspiracy in Bristol Superior Court. He was sentenced to two years in the House of Correction, suspended, $16,072 in restitution and voluntary surrender of his license to practice podiatry. He cannot reapply for a license for ten years. Assistant Attorney General Jennifer Renna Ferreira prosecuted the case.


PROPERTY HIGHLIGHTS

Claims Rep Pads Homeowners Claim

WORCESTER- A Liberty Mutual claims representative filed a claim under her homeowner's policy with Worcester Insurance Company reporting that her home had been burglarized and that numerous items had been stolen. Her itemized list included a television, camera and gold ring. When the Worcester woman was unable to produce receipts for the stolen items, the insurance carrier hired a private investigator. She allegedly admitted to the investigator that she had "padded" her claim by listing the gold ring as stolen. As part of the claim, she also sought compensation for new door locks, yet allegedly confessed to police and the insurance company that the back door had been unlocked at the time of the alleged burglary.

A complaint was issued against a Worcester woman on one count each of insurance fraud and attempted larceny in Worcester District Court on June 19, 1996. The case is being prosecuted by Assistant Attorney General John Ciardi and Special Assistant Attorney General Christian Hatfield.


MARINE HIGHLIGHTS

"Two Halves Don't Necessarily Make a Whole" Case Update

ACUSHNET- Two men reported that a 40-foot O'Day sailboat worth $85,000 that they had restored was stolen. Investigation revealed that two O'Day sailboats, each with existing damage, had been purchased by the men. One boat was severely damaged on the left side and the other was damaged on the right side and the two salvaged sailboats were pieced together to make one. The non-existent "paper" boat was registered, insured and then reported stolen in an attempt to collect the insurance proceeds from Maryland Insurance Group.

Kurt Blaha pled guilty to charges of insurance fraud and filing a false report of theft in Hingham District Court on May 7, 1996. He was sentenced to one year probation. His friend, James Laycock, pled guilty to insurance fraud, making a false affidavit or protest on a ship or vessel, attempt to commit a crime and conspiracy. He was sentenced to 18 months in the House of Correction, suspended for two years, and ordered to perform 250 hours of community service. The case was prosecuted by Assistant Attorney General Kevin Brekka.


AUTOMOBILE HIGHLIGHT

"Like Father, Like Son" Case Update

SEEKONK- A Seekonk businessman reported the theft of his company-owned BMW, office equipment and tools and received $29,000 from Hanover Insurance Company for the loss.

Wayne Clark, Sr. pled guilty to charges of insurance fraud, perjury and larceny in Bristol Superior Court on June 24, 1996. He was sentenced to 36 months in the House of Correction, 18 months to serve, and ordered to pay restitution and fines of $30,000. His son previously pled guilty for the staged theft of a family-owned BMW and was sentenced to a suspended sentence and ordered to pay $7,500 restitution. Assistant Attorney General Stephanie Kelly prosecuted the case.

"Claims Adjuster Authorizes False Checks" Case Update

ROSLINDALE- A former USF&G claims adjuster added names to the claims of legitimate motor vehicle accidents and issued checks totalling more than $13,000 to these individuals. Her brother provided the adjuster with the names of individuals who were willing to participate in the scheme. He then accompanied them to cash their checks, allowed them to keep a few hundred dollars and shared the remaining cash with his sister.

Pamela Lodge Simpson pled guilty to insurance fraud, larceny, forgery and conspiracy on June 18, 1996 in Quincy District Court. She was sentenced to one year in the House of Correction, suspended, and ordered to pay $13,537 restitution and to perform 250 hours of community service. Her brother, Michael Lodge, pled guilty to insurance fraud, larceny and conspiracy. He is currently serving a life sentence for a first degree murder conviction. The case was prosecuted by Assistant Attorney General Anne C. Berlin.

Oh, No! Not Again!

CAMBRIDGE- A 1983 Porsche 928 owned by a Cambridge man was allegedly involved in three separate motor vehicle accidents. In each incident, another vehicle allegedly backed into the Porsche causing front end damage. Photographs and appraisals from the carriers, John Hancock, Metropolitan Property & Casualty and Cigna Property & Casualty, show identical damage inflicted upon the vehicle.

A Cambridge man was indicted on charges of insurance fraud, larceny and conspiracy on June 19, 1996 in Middlesex Superior Court. A complaint was issued against his sister on counts of insurance fraud and conspiracy in Cambridge District Court. Another subject pled guilty to his role in one of the staged accident schemes. He was sentenced to a suspended sentence and fined $3,000. Assistant Attorney General Jennifer Renna Ferreira is prosecuting the case.

"Taxi Service Prohibited for Personal Autos" Case Update

LAWRENCE- Two Lawrence taxicab drivers paid insurance premiums based solely on personal use of the vehicles they operated as taxicabs. They paid minimum personal insurance on their vehicles, about $1,000, when they should have paid the proper, higher rate for taxicabs which was almost $4,000.

Jose Santiago was found guilty of insurance fraud and larceny in Lawrence District Court. He was fined $250. Nicholas Balbi admitted to sufficient facts and was fined $1,000. The case was prosecuted by Assistant Attorney General John Ciardi and Special Assistant Attorney General Christian Hatfield.

"But My Garage Really is Located on the Other Side of the State!" Case Update

LAWRENCE- A Lawrence woman owned two vehicles garaged in Lawrence but claimed to Safety Insurance Company they were garaged in Methuen. Because insurance rates are less expensive in Methuen, she saved $491 in insurance premiums on each car.

Griselda Tejada Vasquez admitted to sufficient facts to support a guilty finding of insurance fraud and larceny in Lawrence District Court. She was ordered to pay $567 in restitution and $567 in court fines. The case was handled by Assistant Attorney General John Ciardi and Special Assistant Attorney General Christian Hatfield.

Stolen Vehicle Located in Virginia

REVERE- A Revere man reported to Cigna Property & Casualty Insurance Company and to police the alleged theft of his vehicle from the Burlington Mall in Massachusetts. Investigation by a Virginia state trooper, however, revealed that the subject=s vehicle caught fire while he was driving it to Virginia. The vehicle was allegedly towed to and given to the subject=s brother in that state who then had the vehicle towed to and stored at the tow company. The tow company ran a vehicle check when the automobile was left in their possession without proper payment of storage charges and discovered that the vehicle had been reported stolen in Massachusetts.

A complaint was issued on May 14, 1996 against a Revere man alleging motor vehicle insurance fraud, larceny, concealment of a motor vehicle to defraud the insurer, conspiracy and perjury in Chelsea District Court. A complaint was also issued against the subject's sister on motor vehicle insurance fraud, larceny, concealment of a motor vehicle and conspiracy for her involvement in the scheme. Assistant Attorney General Sean Kealy is prosecuting the case.

Gigantic Tow Bill

REVERE- A Revere man allegedly filed claims and received payments from two different carriers, Aetna Casualty & Surety and Cigna Property & Casualty, for the same damage to his truck. As part of each claim, the subject allegedly submitted identical bills to recover money for a rental vehicle and towing charges. The tow bill, totalling $6,545, was allegedly fraudulently created with the help of a friend.

On April 23, 1996 in Chelsea District Court a complaint was issued against a Revere man for insurance fraud, larceny, attempted larceny and conspiracy. Another complaint was issued against a Peabody man for insurance fraud and conspiracy. Assistant Attorney General Jennifer Renna Ferreira is the prosecutor in the case.

Bully Commits Insurance Fraud

PLYMOUTH- A Plymouth man claimed that he was operating a friend's vehicle when it was rear-ended by another vehicle. As part of his claim, the subject furnished a Wage Verification Form alleging wages earned. Investigation and witness testimony contend that the Wage Verification Form is a forgery and was actually signed by the friend. The subject allegedly admitted to an eyewitness that he had left his job prior to the accident. The friend and owner of the vehicle admitted she signed the subject's former employer's name because she felt intimidated by the subject and had at one time secured a restraining order against him.

A complaint was issued against a Plymouth man on insurance fraud and attempted larceny in Plymouth District Court on April 2, 1996. Assistant Attorney General Steven Thomas is prosecuting the case.


WORKERS' COMPENSATION HIGHLIGHTS

Broken Ankle Didn't Break This Worker's Earning Capacity

MARBLEHEAD- A slip and fall accident at his place of employment resulted in a Dedham man breaking his right ankle. The subject collected over $30,000 in total temporary workers' compensation benefits from Cigna Insurance Company for the injury. Evidence uncovered showed that the subject worked for and was paid over $80,000 by three different employers during the time period he was receiving the workers' compensation benefits. The subject stated during several IMEs that he had not returned to work in any capacity since the date of the accident.

A Dedham man pled guilty to larceny and was sentenced to two and one half years in the House of Correction, suspended, and probation. He was also ordered to pay $14,000 in restitution. The case was prosecuted in Essex Superior Court by Jennifer Renna Ferreira of the Attorney General's Office.

CPA Convicted of Workers' Comp Fraud

MANOMET-A Manomet certified public accountant claimed to be disabled due to an injury he suffered when he worked for Ticor Title Company in Boston. Investigation revealed, however, that the subject worked at two similar jobs for other employers while collecting over $32,000 in total disability benefits from Cigna Insurance Company.

Harry Honan, a certified public accountant, was found guilty of insurance fraud and larceny in Brockton Superior Court on August 26, 1996. He was sentenced to serve three months in the House of Correction, three years probation and to pay restitution of $32,936. The trial lasted for five days and the jury deliberated for three hours before returning a guilty verdict. Assistant Attorneys General Michael Cullen and Anne Berlin prosecuted the case.

"Security Manager Caught Stealing $97,000" Case Update

LOWELL- As a result of shoulder and back injuries sustained in an automobile accident, a Lowell man received over $97,000 in temporary total disability benefits from his job as the owner of a security company. He was actually employed for several months during the time he collected benefits as the security and maintenance manager of a self-storage facility and was also running a mail order business out of his home. He submitted statements to Continental Insurance Company claiming that he was not working while he was receiving the benefits.

Richard DiChiara pled guilty to workers' compensation fraud, insurance fraud and larceny in Middlesex Superior Court on May 6, 1996. He was sentenced to serve three months in the House of Correction, three-to-five years in state prison, suspended for two years, probation, and to perform 100 hours of community service. DiChiara was also ordered to pay over $90,000 in restitution through a civil proceeding. Assistant Attorney General Kevin Brekka prosecuted the case.

"Keeping His Brother's Memory Alive" Case Update

SPRINGFIELD- A subject sustained a work-related injury while in the employ of a roofing company. Maryland Casualty Insurance Company paid him temporary total disability benefits for almost a year when he was then assigned an earning capacity and received partial disability benefits until the benefits were discontinued. During several IME's, the subject stated that he had not returned to work since the date of the accident. However, investigation revealed that he was employed as a roofer for sporadic periods during his time of disability and was using the identity of his deceased brother.

A Springfield man pled guilty to insurance fraud, larceny and procuring a false certificate of registration in Springfield District Court on April 9, 1996. He was sentenced to two years supervised probation and restitution. Assistant Attorney General Steven Thomas prosecuted the case.

"All Fenced In" Case Update

HOLBROOK- A Holbrook man collected temporary total workers' compensation benefits from Cigna Insurance Company for almost two years for a total of $31,263 after he injured his back while employed as a painter. During a routine activity check on the subject conducted by Cigna, he was photographed and videotaped measuring job sites for installation of fences and performing the installation for his own company. The subject's girlfriend provided proposals for the installation of fences to customers and the checks were made payable to her. The subject signed an Employee Earnings Report indicating that he had not received any earnings for any period he was entitled to receive workers' compensation benefits.

Rodger Lydiksen pled guilty to insurance fraud, workers' compensation fraud, larceny and conspiracy. He was sentenced to two years in the House of Correction, suspended for three years, a $10,000 fine and restitution of $5,000. Lydiksen has already paid restitution to Cigna Insurance ordered during a civil process. His girlfriend was placed on pre-trial probation. Assistant Attorney General Jennifer Renna Ferreira handled the case.

Mere Injury Doesn't Hinder Good Service

ARLINGTON- A subject sustained a work-related injury and collected a total of $2,700 in accordance with a long-term disability insurance policy provided by his employer. The subject made several written statements to Universal Underwriters Insurance Company that he had not returned to work. However, he allegedly was employed full-time as a concierge while continuing to collect long-term disability benefits. He also received $1,160 per month in social security disability payments during the same period he was working full-time as a concierge but claiming the alleged disability.

A complaint was issued against an Arlington man on two counts each of insurance fraud and larceny in Cambridge District Court on April 4, 1996. Assistant Attorney General Shelley Richmond is prosecuting the case.