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December 21, 2012

ATTORNEY, ACCOUNTANT, AND TWO ADMINISTRATORS SENTENCED TO PRISON FOR REVENUE AND TAX CHARGES IN $154 MILLION MEDICAL INSURANCE FRAUD SCHEME

Filed under: California Defense Attorney — Tags: , , , — fayarfa @ 4:25 pm

* Additional felony fraud counts for the defendants will be tried at a later date

SANTA ANA - An attorney, accountant, and two administrators were sentenced today for violating revenue and tax codes for their roles in the largest medical fraud prosecution in the nation for recruiting over thousands of healthy patients to undergo unnecessary and dangerous surgeries to fraudulently bill medical insurance companies. This trial involved the failure to file tax returns and under-reporting income to state tax authorities. The court bifurcated the case due to its size and volume and additional fraud charges remain pending a pre-trial hearing for those counts is scheduled for Jan. 3, 2013, at 1:30 p.m. in Department C-41, Central Justice Center, Santa Ana.

Roy Chester Dickson, 64, Yorba Linda, Unity’s attorney, was sentenced to two years and eight months in state prison and $41,629 restitution. He was found guilty by a jury Nov. 26, 2012, of two felony counts of filing a false personal tax return and faces a maximum sentence of three years and eight months in state prison for these counts. Dickson faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of money laundering, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.

Andrew Robert Harnen, 58, Rosemead, Unity’s accountant, was sentenced to five years and four months in state prison and $904,780 restitution. He was found guilty by a jury Nov. 26, 2012, of three felony counts of filing a false tax return and six counts of failing to file tax returns. He faces a maximum sentence of eight years and four months in state prison for these counts. Harnen faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.

Dee Francis, 63, a Unity administrator, was sentenced to six years in state prison and $905,507 restitution. She was found guilty by a jury Nov. 26, 2012, of one felony count of filing a false tax return and six counts of failing to file tax returns. He faces a maximum sentence of seven years in state prison for these counts. Francis faces 102 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, two counts of failing to file tax returns, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts.

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November 9, 2012

Ventura County Insurance Broker Arrested on Federal Charges Alleging He Bilked Clients, Including Celebrities, out of $800,000

Filed under: Los Angeles Criminal attorney — Tags: , — fayarfa @ 6:23 am

LOS ANGELES – Federal authorities this morning arrested a Thousand Oaks man on federal mail fraud charges that allege he overbilled clients hundreds of thousands of dollars for insurance policies.

Jerry B. Goldman, 59, was arrested without incident this morning at his residence. He is expected to be arraigned on a 10-count indictment this afternoon in United States District Court in Los Angeles.

The indictment alleges that Goldman used his Newbury Park insurance agency to obtain various insurance products for clients, some of whom were overbilled by as much as 600 percent. The indictment lists four victims, including Tom Hanks and Andy Summers.

According to the indictment, Goldman negotiated premiums for insurance coverage on behalf of his clients, and he was paid commissions by the insurance provider on each policy. Goldman allegedly created fraudulent invoices on his company’s letterhead that inflated the premiums due by as much as 600 percent. From 1998 through August 2011, Goldman received overpayments of more than $800,000, the indictment alleges.

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed to be innocent until and unless proven guilty in court.

Each of the 10 counts of mail fraud alleged in the indictment carry a statutory maximum penalty of 20 years in federal prison.

October 12, 2012

Insurance Sales Associate Charged with $4 Million Disability Insurance Scheme

Filed under: California Defense Attorney — Tags: , — fayarfa @ 3:25 pm

SANTA ANA, California – A former sales associate with the American Family Life Assurance Company, or AFLAC, was arrested today on mail fraud charges involving the defrauding of $4 million in disability benefits from AFLAC in a fictitious employer scheme.   This indictment was part of a crackdown in the last year on fictitious employer schemes that deplete federal, state, and private unemployment and disability insurance program resources, at a time when such resources are most needed.

Fictitious employer schemes target federal, state, and private unemployment and disability insurance programs, which provide benefits to workers who are out of work through no fault of their own or suffer non-work related injuries and are unable to work.  In a fictitious employer scheme, co-schemers register fictitious businesses, that do not do any business and have no real employees.  After registering the fictitious businesses, co-schemers file claims as fictitious employees of the fictitious businesses who lost their jobs or are injured, and collect a stream of unemployment and/or disability insurance benefit checks, which are sent by mail.

Patricia Diane Smith Sledge, 56, of Irvine, was charged by a federal grand jury with four counts of mail fraud for her part in a scheme to submit fraudulent disability insurance claims to AFLAC for fictitious businesses with fictitious injured employees.  According to the indictment, Sledge was a sales associate at AFLAC who sold disability policies to co-schemers with fake businesses and solicited fake employees for such businesses, including Litetouch Investments and Blue Diamond Services.  Soon after obtaining the policies, the fictitious employees claimed fake injuries and AFLAC sent disability benefit checks by mail to the claimants.  Sledge allegedly received a portion of the illegally obtained proceeds from the claimants.  AFLAC terminated Sledge in October 2011 after conducting its own internal investigation.

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September 24, 2012

Three Indicted, Arrested on Federal Charges Involving Scheme to Defraud Insurance Lenders

Filed under: California Defense Attorney — Tags: , — fayarfa @ 5:54 pm

Three people were arrested today on federal charges alleging they operated a scheme to defraud insurance finance companies, announced André Birotte, Jr., the United States Attorney in Los Angeles; Timothy Delaney, the Special Agent in Charge of the FBI’s Los Angeles Field Office; and Insurance Commissioner Dave Jones, on behalf of the CDI Investigations Division-Criminal Operations Point of Sale (COPS) Team-Los Angeles Regional Office.

Lee Anthony Corlette, 64, of Redondo Beach, was arrested at his residence this morning. Sherman Franklin Hulsey, 60, of Santa Barbara; and Jane Graves, 61, of Astoria, Oregon, were also arrested this morning. The defendants will have an initial appearance in U.S. District Court this afternoon.

A federal grand jury returned an indictment in United States District Court in Los Angeles on September 5, charging Corlette with seven counts of mail fraud, nine counts of wire fraud, and 16 counts of aiding and abetting in connection with a scheme to submit numerous fraudulent insurance premiums to insurance finance companies. Hulsey and Graves were charged with one count of mail fraud, three counts of wire fraud, and four counts of aiding and abetting. The indictment alleges that Corlette, while CEO of Insurance Works Inc., and doing business as Star Alliance Insurance Services in Long Beach, California, obtained over $4 million in fraudulent loans from victim finance companies who believed the money would be provided to the insurance carriers identified in the agreements submitted by Corlette.

Defendants Hulsey and Graves allegedly assisted Corlette in the fraud by providing information about their businesses in order for Corlette to submit the agreements to the victim finance companies and fraudulently obtain the loans. Hulsey is the owner of Liberty Paradise LLC, located in Santa Barbara, and Global Consulting Services Inc, doing business as Vanguard Benefits. Graves was the secretary/treasurer of Global Consulting Services and the owner of Steward Holdings LLC, a company located in Astoria, Oregon.

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September 4, 2012

ATTORNEY, ACCOUNTANT, AND TWO ADMINISTRATORS ON TRIAL FOR REVENUE AND TAX CHARGES FOR THEIR ROLES IN $154 MILLION MEDICAL INSURANCE FRAUD SCHEME

Filed under: California Defense Attorney — Tags: , , — fayarfa @ 8:52 pm

* Additional felony fraud counts for the defendants will be tried at a later date

SANTA ANA - The trial against attorney, accountant, and two administrators began today on revenue and tax charges for their roles in the largest medical fraud prosecution in the nation for recruiting over 255 healthy patients to undergo unnecessary and dangerous surgeries to fraudulently bill medical insurance companies. The court bifurcated the case due to its size and volume. This trial involves the failure to file tax returns and under-reporting income to state tax authorities.The other fraud charges remain pending and another trial date will be set after the completion of this trial. Opening statements started today in Department C-41, Central Justice Center, Santa Ana.

Roy Chester Dickson, 64, Yorba Linda, Unity’s attorney, is on trial for one felony count of perjury, three felony counts of filing a false personal tax return, and one felony count of failing to file a corporate tax return. If convicted, Dickson faces a maximum sentence of five years in state prison for these counts. Dickson faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of money laundering, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts. These counts will be tried at a later date.

Andrew Robert Harnen, 58, Rosemead, Unity’s accountant, is on trial for four felony counts of filing a false tax return, nine counts of failing to file tax returns, and four felony counts of aiding and abetting the false reporting of taxable income. If convicted, Harnen faces a maximum sentence of 11 years and eight months in state prison for these counts. Harnen faces 101 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts. These counts will be tried at a later date.

Dee Francis, 62, a Unity administrator, is on trial for one felony count of perjury, one felony count of filing a false tax return, and nine counts of failing to file tax returns. If convicted, Francis faces a maximum sentence of nine years in state prison for these counts. Francis faces 102 additional felony counts which include two counts of conspiracy, eight counts of capping or paying for referrals, 30 counts of grand theft, 30 counts of insurance fraud, 30 counts of making false and fraudulent claims, one count of filing a false tax return, two counts of failing to file tax returns, and white collar sentencing enhancements for taking over $2.5 million on the fraud counts. These counts will be tried at a later date.

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August 30, 2012

Long Beach-Based Health Plan Pays Nearly $320 Million to Settle Allegations that it Received Overpayments for Medi-Cal Patients

Filed under: California Defense Attorney — Tags: — fayarfa @ 5:52 pm

SCAN Health Plan Pays Another $3.82 Million to Resolve Claims of Inflated ‘Risk Adjustment Scores’ that Increased Reimbursements from Medicare Part C

LOS ANGELES – In the largest recovery ever obtained from a single Medi-Cal provider, a Long Beach-based managed care health plan has paid $319.85 million to resolve allegations that it received overpayments from Medi-Cal.

On August 10, 2012, SCAN Health Plan paid $129,380,632 to the federal government and $190,470,301 to the State of California to resolve an investigation into overpayments for services provided to long-term-care patients.

Medi-Cal, which is California’s Medicaid program, is jointly funded by the federal government and the State of California. The federal government’s investigation found that the State of California paid SCAN rates for long-term-care-certified (LTC) patients that were over the legal ceiling set by a California statute and regulations.

“This massive settlement demonstrates the commitment of the United States Justice Department to eradicate fraud, waste, and abuse in this nation’s public health care programs,” said United States Attorney André Birotte Jr. “We want the entire health care industry to know that we will use every tool at our disposal to ensure that the taxpayers are getting what they pay for when they finance public health programs.”

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July 13, 2012

Business Owner is Charged with Workers’ Compensation Insurance Fraud in Orange County

Filed under: California Defense Attorney — Tags: — fayarfa @ 4:55 am

GUERRERO, JOSE LUIS Between March 2005 and March 2009, Guerrero, a tree trimming business owner, is charged with illegally paying employees with $2 million which he failed to report to avoid paying Workers’ Compensation Insurance premiums and State taxes.

Guerrero is accused of denying his employees the benefit of State unemployment and disability insurance.

When an employee was injured, Guerrero is accused of filing an insurance claim against his SCIF policy without having paid a premium for that employee. On May 2, 2007, one of Guerrero’s employee’s was seriously injured, rendering him unable to work.

The defendant is accused filing an insurance claim against his SCIF policy for this employee, even though he had never claimed or paid an insurance premium for him.

On Nov. 7, 2007, an employee was killed while working and Guerrero is accused of filing an insurance claim against his SCIF policy to collect benefits for Gonzalez’s family without ever having paid an insurance premium. SCIF discovered the fraud while reviewing Guerrero’s business following employee’s death.

During a subsequent search of the defendant’s home, Guerrero is accused of being in possession of an assault weapon.

May 11, 2012

Beverly Hills Dentist Accused of Insurance Fraud in Excess of $300k

Filed under: Los Angeles Criminal attorney — Tags: — fayarfa @ 1:33 am

LOS ANGELES – A Beverly Hills dentist was arrested today on a 101-count felony complaint alleging insurance fraud exceeding $300,000 in losses, the District Attorney’s Office announced.

Tom K. Kalili, 57 (dob 9/24/54), is charged in case No. BA394506 with grand theft and tax evasion with an excessive-taking allegation. Kalili is expected to appear for arraignment early next week in Department 30 of the Foltz Criminal Justice Center.

The filing concludes a multi-year joint investigation by the California Department of Insurance, the California Dental Board and the California Franchise Board. Kalili owns and operates Beverly Hills Medical Suites, a dental office.

The defendant’s office manager and biller, Claudia Ventura, 38 (dob 9/19/73), is charged with 10 felony counts including insurance fraud and accessory after the fact. She will be arraigned with Kalili next week.

Bail for Kalili is recommended at $500,000. Co-defendant Ventura’s bail is recommended at $25,000.

If convicted as charged, Ventura faces more than seven years in state prison. Kalili could be sentenced to more than 50 years in prison.

April 13, 2012

Los Angeles City Firefighter Charged with Fraud

Filed under: Los Angeles Criminal attorney — Tags: , — fayarfa @ 2:39 am

LOS ANGELES – A Los Angeles City firefighter and mixed martial arts fighter was arrested today by District Attorney’s investigators for allegedly filing false workers’ compensation insurance claims, the District Attorney’s Office announced.

Capt. Stephen De Prima with the D.A.’s Bureau of Investigation said Raphael Davis, 35, was arrested at his Lomita home about 9 a.m. without incident. He is being held on $30,000 bail.

Head Deputy John Morris with the D.A’s Healthcare Fraud Division said prosecutors filed four felony counts of insurance fraud on Monday against Davis, who allegedly filed for workers’ compensation insurance between Dec. 2, 2008, to May 20, 2011.

Investigators said that while he allegedly filed false claims, he was participating in mixed martial arts fights as “The Noodle.”

If convicted as charged, he’s facing up to five years in county jail.

March 27, 2012

WOMAN SENTENCED TO LIFE IN PRISON WITHOUT PAROLE FOR MURDER-FOR-PROFIT CONSPIRACY TO HAVE CANCER-STRICKEN HUSBAND KILLED

Filed under: California Defense Attorney — Tags: , , — fayarfa @ 8:04 am

SANTA ANA - A woman was sentenced today to life in state prison without the possibility of parole for conspiring to have her third husband murdered so she could save money by not paying for his cancer treatments and financially profit from his insurance and 401(k) death benefits. Sandra Jessee, 61, formerly of Placentia, was found guilty by a jury Dec. 7, 2011, of one felony count of special circumstances murder for financial gain and one felony count of conspiracy. Jessee was convicted in a re-trial of the case, as a previous jury was unable to reach a unanimous verdict on July 21, 2009.

Sandra Jessee’s son from a previous marriage Thomas Dayton Aehlert, 42, Gold Canyon, AZ, pleaded guilty in this case Oct. 7, 2011, to one felony count of second degree murder and faces a sentence of 15 years to life in state prison at his sentencing Sept. 7, 2012, 2012, at 9:00 a.m. in Department C-35, Central Justice Center, Santa Ana.

Co-defendant Thomas Joseph Garrick, 36, Laguna Hills, is charged with one felony count of special circumstances murder for financial gain and one felony count conspiracy to commit murder. He faces a maximum sentence of life in state prison without the possibility of parole if convicted. The defendant is being held without bail and is scheduled for a preliminary hearing April 27, 2012, at 9:00 a.m. in Department C-55.

In the spring of 1998, Sandra Jessee’s third husband of 15 years, 56-year-old Jack Jessee, was diagnosed with cancer.  Sandra Jessee wanted to move to Arizona, where Aehlert had recently moved. The victim did not want to leave California, where his adult children lived.

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