You Can't Make This Stuff Up: The Worst Cases of Insurance Fraud in 2014
January 27, 2015 8:31 AM
Case No. 1: Attorney Builds Assembly Line to Manufacture Auto Injuries
Personal-injury lawyer Joseph Haddad, working in concert with the owner of a chain of chiropractic clinics, an unlicensed doctor and a medical diagnostics testing company, ran an industrial-scale insurance fraud centered on victims of minor traffic incidents.The Bridgeport, Connecticut-based attorney bought police accident reports that identified the victims. His agents then induced the motorists to get treatment at the medical facilities aligned with Haddad, which would inflate the seriousness of the patients' conditions. Over 145 prescriptions for more than 4,400 pills were written for accident victims who were never diagnosed.According to the U.S. Attorney's Office, more than 10 insurance carriers lost up to $2.5 million as a result of the conspiracy. Haddad pleaded guilty to mail fraud and conspiracy to commit mail fraud, and agreed to pay $1.75 million in restitution to his victims.
Case No. 2: Exotic Auto Dealer Makes Wrong Turn on the Internet
Selling exotic sports cars was Andy Houses profession. Sinking one for the insurance money was purely amateur hour, when he was caught in the act on camera. House drove a rare $1-million Bugatti Veyron into an East Texas lagoon and then filed an inflated $2.2-million insurance claim.Only 300 Veyrons were ever produced. Geared to reach more than 250 mph, it is one of the worlds rarest street-legal sports cars. One month prior to his accident, House bought the car with a loan from a friend, and then insured it for double the price as a collectors car. Another motorist saw House driving the Bugatti down the road to the lagoon. Awed by the vehicle, he whipped out his cellphone in time to capture House calmly steering the car into the water. The video went viral on YouTube and became an online sensation.House pleaded guilty to insurance fraud and faces up to 20 years in federal prison when sentenced.
Case No. 3: Oncologist Operates Cancer Fraud Factory
Cancer was good to Dr. Farid Fata. He pumped patients full of toxic levels of chemotherapy, whether they needed it or not. The Detroit-area oncologist billed private insurers and Medicare $225 million, with insurers paying out $91 million in claims. But Fata often administered toxic levels of medications that patients didnt need. One cancer-free patient received 155 treatments over two years. Fata also ordered high doses of chemo for patients who were near death and beyond hope of recovery and charged insurers for chemo treatments that were never administered.Fatas scheme began to unravel after a chemotherapy nurse in his employ reported him to Michigans medical authorities. Eventually the federal government brought charges, and he pleaded guilty to 13 counts of health-care fraud.Barbara McQuade, the U.S. Attorney prosecuting the case, said she plans to seek life in prison for Fata, calling his case is "the most egregious" health care fraud case her office has seen.
Case No. 4: New York Cop Rocks Out on Disability
Moonlighting as the lead singer for a punk rock band, New York City police officer Christopher Inserra danced and gyrated and on stage. It was an impressive performance that he blithely posted on YouTube. There was only one catch: At the same time that he was fist-pumping he was also collecting medical disability payments for an enfeebled right arm. Inserra claimed he hurt the arm while taking an injured Port Authority employee to a medical facility. Medical exams found no serious injuries, but Inserra complained he was in so much pain that he couldn't bend his arm. The police department gave him time off with his full $90,000 salary plus disability pay.Alerted by the YouTube video, federal prosecutors charged him with insurance fraud. Inserra pleaded guilty, received five years probation and resigned from the police force. He will also have to repay the stolen disability money.He betrayed that and his brothers and sisters in the police department, federal prosecutor Robert Capers said. He milked the system as a member of law enforcement.Ironically, while he was on tour with his band, Inserra performed songs entitled My Sweet Disgrace and Walk of Shame.
Case No. 5: Orthopedist Submits $35 Million in Claims for Phantom Surgeries
Dr. Spyros Panos was a star performer at the Poughkeepsie, NY medical facility where he worked, bouncing from operating room to operating room while performing at least 20 procedures a day. There was just one problem: Many of the surgeries billed out by the orthopedist never took place. Panos would fake surgeries for patients who were under anesthesia, opening and then closing them without repairing any joints. He also performed arthroscopic procedures and then billed them as more-expensive open surgeries. One such surgery lasted all of seven minutes. In total, the good doctor submitted $35 million in false insurance claims.For committing insurance fraud, Panos was sentenced to four-and-a-half years in federal prison. He also faces at least 260 lawsuits from patients who allege they were needlessly and often carelessly cut up for insurance money.
Case No. 6: Woman Bilks Blue Cross with Phony Claims of Rape and Cancer
Cervical cancer was clawing its way through Sara Ylen, leaving her six months to live. It was triggered when a stranger raped her in a parking lot. The assault gave her a sexually transmitted disease that caused the metastasizing cancer.A heart rending story; only none of it was true. For years, the Port Huron, Mich.-area woman used the remarkable fairy tale and forged medical documents to bilk her insurer out of payments for un-needed hospice care. She was finally tripped up when a friend spotted one of the X-rays Ylen had used online.Last January, Ylen pleaded no contest to insurance fraud and received a one-year sentence. That will run concurrently with another five-year sentence she received for falsely accusing two men of rape. Ylen also owes about $122,000 to Blue Cross Blue Shield of Michigan, mostly for the hospice care. A 2012 event at a local-area church raised $10,800 for her bills, but the church has not asked for repayment. That was just a fraction of the money donated to Ylen by sympathetic friends and neighbors over the years.
Case No. 7: Mentally-Challenged Man Murdered for a $15,000 Life Insurance Policy
Buddy Musso had the intellect of an eight-year-old and stayed at an assisted-living facility, across the Hudson River from Manhattan. When he was 59, he met Sue Basso at a church carnival in New Jersey and fell in love.Basso lured Musso to the Houston area with promises of romance. After they were married, she purchased him a small $15,000 life insurance policy naming herself as the beneficiary. The policy, however, would pay out $60,000 in the event that Buddy died a violent death.Basso intended to make sure that he did. She hired a gang of thugs to kick and beat Buddy with belts, baseball bats and steel-toed shoes. They also scrubbed his body with a wire brush, and doused him with a mixture of chlorine bleach and pine-oil disinfectant. The police found his body dumped by a roadside.Basso became a suspect after reporting Buddy missing, following the discovery of his body. She was arrested and charged with torture and murder, and her daughter was among the witnesses testifying against her at her trial. Found guilty, she was executed by lethal injection under Texas law last February.