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Category Archives: 47M Insurance Fraud Victories

State v. Mr. K (DMC N. 11324) – Insurance and Medical Billing Fraud – Vacated Suspension of Physical Therapy License at Board Hearing – Arizona Board of Physical Therapy (Complaint No. 12-41):  Mr. K worked as a physical therapist and had submitted various medical bills to assisted healthcare services.  It was alleged that he billed for some services that he did not actually perform.  Once we were involved in the case, we were able to show that his billing practices may have fallen below the standard of ethics, but they were not criminal in nature.  This was true, even though they were claiming he had falsified his records.

We were able to get the case dismissed with an agreement to probation.  As a condition of probation, Mr. K was required to do classes in continuing education, along with monitoring of his billing submissions.  After one year, the probation was lifted and his license was unencumbered.  He was allowed to maintain his livelihood throughout the entire course of his probation.

State v. Mr. K. (DMC No. 13080 and DMC No. 11324) – Felony Medicare Insurance/Benefits Fraud ($1,500 Misappropriated from Medicare), Felony Fraudulent Schemes and Felony Forgery – Not Charged and Physical Therapy License Not Revoked at Professional Hearing – Arizona Board of Physical Therapy Investigated.

Mr. K worked as an independent homecare contractor regarding services for physical therapy. Mr. K allegedly billed Medicare for 15 home visits on a client in which he only did 7 visits. He was accused of signing the patient’s name on the visit confirmation slips for all 15 visits. He was eventually contacted by the Arizona Board of Physical Therapy regarding allegations of Medicare Insurance Fraud, Fraud Schemes, and Forgery.

We became involved when we represented Mr. K in front of the Arizona Board of Physical Therapy. Discrepancies in the record were clarified and Medicare was made whole. In the end, Mr. K was not charged with any criminal charges and he was allowed to keep his physical therapy license.

Felony Benefits Fraud ($50,800 Misappropriated from SSI), Felony Fraudulent Schemes and Felony False Swearing Reduced to Probation with Zero Days of Actual Jail – State v. Ms. M (DMC No. 12750) (Maricopa County Superior Court CR2014-002739): Ms. M was born without part of her arm.  She was on SSI Benefits and had to fill out regular forms with the Social Security Administration.  She became married to a gentleman who made good money, and who owned several houses.  In addition, she received a $250,000 civil settlement (which left her with $100,000 after attorney’s fees and cost).  She did not report any of these to the Social Security Administration and, in fact, signed forms stating she was not married and had no other income.

When she was interviewed by the Social Security Agency, she denied being married.  When they showed her a copy of her marriage certificate, she broke down and confessed to the entire scheme.  She was then charged with Fraudulent Schemes Involving Benefits Fraud, Theft and False Swearing.  If all charges were run consecutively and she was sentenced to the maximum, she would do almost 30 years in prison.

We became involved and we were able to show some of the hardships that Ms. M had faced.  We also showed through Mitigation that she was truly remorseful and was now seeking counseling to deal with the loss of her arm and medical situation. Ultimately, we were able to get the charges reduced and the Judge sentenced Ms. M to probation with Zero Days of Actual Jail.

INSURANCE FRAUD/FRAUD SCHEMES ($19,900) REDUCED to class 6 Open/Misdemeanor THEFT which was later REDUCED to a MISDEMEANOR with PROBATION and ZERO DAYS in JAIL. – State v. Mr. & Mrs. B (DMC No. 4545 & 4546) (Pinal County Superior Court CR 2004-00404; CR 2004-00405): Mr. and Mrs. B had purchased a Harley Davidson motorcycle which cost over $20,000. They hid the motorcycle in their garage and called their insurance company in order to file a claim. They were eventually paid $19,900 for the motorcycle. Insurance company investigators became suspicious and photographed Mr. B on the motorcycle. Ultimately, Mr. & Mrs. B were both charged with Insurance Fraud & Theft. They then sought out our help and signed off on Conflict Waivers regarding any potential conflict between us representing both of them. They both were fully aware they were admitting their wrong doing, and we were seeking to avoid Prison time. We were able to convince the Prosecutor to reduce the charge to a Class 6 Open/Misdemeanor with Probation and zero days in Jail in exchange for Restitution. Both successfully completed Probation and the charges were reduced to Misdemeanors. Neither has a Felony conviction on their record.

INSURANCE FRAUD ($59,000) AND FRAUDULENT SCHEMES NOT CHARGED – State v. Mr. G. (DMC No. 5236) (Arizona Department of Insurance/Arizona Attorney General’s Office Investigated): Mr. G. and his wife owned a company that installed glass for store front windows. Their controller had begun writing personal checks and embezzling from their company. She was doing this by forging Mr. G’s signature. Mr. and Mrs. G ultimately terminated the employee and filed claims with their insurance company. The insurance company and the Attorney General’s Office began investigating Mr. and Mrs. G because the checks had appeared to have been signed by them. In addition, the former Controller was falsely claiming that Mr. and Mrs. G had signed the checks and that they were committing fraud.

We were able to begin an investigation in which we went back to the Controllers former employers and ex-husband. They all indicated that she had stolen in the past and was a “thief” and “liar”. We also brought in a hand writing expert who proved that Mr. and Mrs. G had not signed the checks. This was all presented to the Department of Insurance and the Arizona Attorney General’s Office, and no charges were brought against Mr. and Mrs. G. Their former Controller, however, was charged with multiple crimes.

INSURANCE FRAUD ($23,000) and THEFT of MEANS of TRANSPORTATION NOT CHARGED; FALSE REPORTING DISMISSED – State v. Mr. C (DMC No. 8485) (Surprise City Court CR07-01028/Surprise Police Department DR 07096356): Mr. C had gone to Las Vegas to get married, and when he got back his truck was missing. It was found by the Peoria Police Department burned out in the desert. This was then reported to the Surprise Police Department, and Mr. C had filed a stolen vehicle report. The police and insurance company became suspicious and interviewed a friend of Mr. C’s who stated that Mr. C had another friend named “Greg” steal the vehicle and burn it so he could file an insurance claim in order to recover $23,000.

We became involved in the case, and dealt directly with the Detective on Mr. C’s behalf. The Detective filed a direct complaint into the Surprise City Court for False Reporting. We ultimately got this charged Dismissed. In addition, the Detective routed his file over to the Maricopa County Attorney’s Office to be reviewed for charges of Insurance Fraud and Theft of Means of Transportation. Due to our intervention, no charges were brought against Mr. C. If he would have been charged, he could have done time in prison.

REDUCED | FELONY FALSE INSURANCE CLAIM – (Maricopa County Superior Court No. CR2010-163256-002)(DMC 10132): Mr. V. was accused of driving his girlfriends BMW into Mexico, abandoning it there, and then assisting her in filing a false insurance claim.  He was later interviewed by the insurance company and stated that the car was left in the driveway with the key in the ignition in Arizona.  Due to the fact that he was merely assisting his girlfriend and did not receive any benefit, we were able to negotiate a plea to a Misdemeanor which included 6 months of unsupervised probation and 0 days in jail.  His girlfriend used a different attorney and went to prison.

INSURANCE FRAUD/AUTO THEFT NOT CHARGED – State v. Mr. P. (DMC No. 8525) (Arizona Department of Insurance Investigated): Mr. P had purchased a 1 year old Chevy 4×4 truck with lots of amenities. He had the truck for several months, when it was stolen. He reported the theft to his insurance company and filed a claim. He later received a call from Police stating the vehicle was found in Mexico. When he called his insurance company to inform them, they stated that they were already aware of this and felt that he was involved in the theft of his own vehicle in order to file an insurance claim.

After receiving a letter from the Department of Insurance Investigator, he contacted our office. We were able to show that there was no motive for Mr. P. to steal the vehicle (i.e. He was not in financial hardship, nor was there a mechanical problem with the vehicle), and that he was willing to take a lie detector test. After all documentation was forwarded to the Maricopa County Attorney’s Office, we met with the charging Attorney who agreed that no charges would be filed against Mr. P. We also sent a scathing letter to the Insurance company indicated that if they pursued this further that they would be sued for “bad faith”. Mr. P. has no criminal history.


NOT CHARGED | STATE RICO, FRAUD SCHEMES, INSURANCE FRAUD and THEFT – State v. Ms. L. (DMC No. 6458) (Department of Insurance Fraud Unit DR05-00084/Arizona Attorney General’s Office Investigated): Ms. L. had filed several police reports alleging that several vehicles had been stolen, which were later found in the desert burned.  Due to Ms. L.’s prior criminal history, the Department of Insurance Fraud Unit began investigating her, along with the Arizona Attorney General’s Office.  It was suspected that she was running an illegal enterprise which involved faking the theft of vehicles in order to secure insurance proceeds.  Although the Department of Insurance turned the case over to the Attorney General’s Office, we were able to convince them not to file charges against Ms. L. due to a lack of probable cause.


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