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Zalma's insurance fraud letter – June 1, 2019



Sickness, recovery needs to be changed

Insurance fraud is redundant. Hal Kreitman was convicted of fraud, conspiracy to commit letter fraud, money laundering and conspiracy to commit money laundering to participate in a system that deceived insurance companies. The scheme was as elaborate as it was criminal. The conspirators recruited people to lead car accidents and seek "treatment" at one of several clinics run by conspirators. At the clinic, a conspiratorial chiropractor, like Kreitman, would print dozens of false treatment sessions for the "injured" person, the insurance companies for the insurance company for the cost, and lock the money.

In the US by Hal Mark Kreitman, No. 1
8-12838, United States Appeal Court for the Eleventh Circuit (May 20, 2019) Hal Kreitman appealed the Court's 84-month prison sentence and two-year surveillance. He also charged the court's order to repay $ 795 945.51.

FACTS

For his role in this system, Kreitman was sentenced to 96 months' imprisonment and 2 years of supervised release and ordered to pay more than $ 1.5 million repayment and an estimate of $ 2,500. On appeal, the 11th circuit provided its punishment and repayment order, as the court wrongly held him responsible "for all the loss generated during the conspiracy" as opposed to "all reasonably foreseeable" losses. In addition, the district court failed to "make individual facts about the extent of criminal activity done by Kreitman."
Following the instructions of the eleventh circuit, the district court re-examined the evidence and found that the actual loss was $ 795 945.51 and that ten or more victims were involved. The district court calculated Kreitman's new guideline as 78 to 97 months, which the court characterized as "an appropriate interval … to work with" and "enough but not greater than what is required to fulfill the requirements in section 3553."

The Court introduced since an 84-month sentence followed by two years of supervised release. The court also ordered Kreitman to pay $ 795 945.51 in repayment.

ANALYSIS

A district court abuses its discretionary space if it adheres to erroneous procedures in determining a sentence. Kreitman argued that the district court had incorrectly calculated the scope of the guideline by relying on unreliable government calculations of claims, not identifying and excluding insurance damages involving legitimate patient treatment and speculating that more than ten offenses were involved.

The sentencing guidelines introduce an improvement of 14 levels if the actual loss attributable to the defendant is more than $ 550,000 and less than or equal to $ 1.5 million. The Kreitman lawyer admitted at the conviction that even if the billing was turned off, the errors "will not be anywhere near getting [Kreitman] down to 550" – or $ 550,000. The district court had the right, with the concession of the council, to find that the loss was over $ 550,000 and corresponded to an improvement of 14 levels.

Since the district court did not clearly mistakenly find that Kreitman's crime comprised ten or more victims, he presented no argument on appeal that persuaded the eleventh circle that the court clearly stated was incorrect.

Although it is assumed that only insurance claims made by Kreitman's patients after August 28, 2010 can be counted, the record shows that there were thirteen insurance companies that paid on or after that date. In addition to Kreitman's entry, it was a testimony that single payments would have been consistent with the fight against fraud because the government only introduced bills related to Kreitman – not the bills attributable to his co-conspirators or anyone else.

Regarding the recovery order, It seems that the court acknowledged that some of the invoice numbers "may be erroneous" but credited the government number in any case, since the mistakes would not lower the scope of the guideline. This was wrong.

If Kreitman is correct about these mistakes, it is doubtful that he could pay the repayment amount based on them, even though his guideline was the same because a criminal defendant cannot be forced to pay repayment for behavior committed outside the plan, conspiracy or pattern of criminal Behavior that underlies the belief in conviction.

Since the court did not make a meaningful commitment to Kreitman's argument on the amount of the loss when it was determined, the interval of the guideline would be unchanged at the eleventh circle, leaving the recovery order again and urging the court to reconsider all evidence. If Kreitman wants to exercise his argument that some money should be withdrawn from the repayment order because he actually treated injured patients, he must provide some evidence of what it should be.

The court, after hearing what a good prisoner Kreitman was and how sick his mother was, still chose to follow the guideline and decided that a sentence of 84 months was appropriate and sufficient. The eleventh circle noted that this was not an abuse of discretion. In fact, there was a justified assessment of the evidence that an appeal court does not have the freedom to interfere with the appeal.

ZALMA OPINION

Insurance criminals, when caught and convicted, have the incessant gall to dispute their sentence and raise appeals proving how profitable the insurance fraud is, since they have sufficient funds to pay lawyers to get more appeals and with some success. His recovery order was lowered once and is likely to be lowered again. Because he will continue to be in prison for many years – unless the US Marshall finds its assets and collects a refund for the victim's victim – he will never pay.

Guilty to participate in $ 30 million plan to deter Medicare and Medicaid

PAUL J. MATHIEU and physiotherapist Doctor HATEM BEHIRY were all justified in participating in a $ 30 million program to defraud Medicare and New York State Medicaid Program. The defendants were sentenced after a six-week jury trial before the US district director Lorna G. Schofield.

According to the evidence presented during the trial and statements made in related court proceedings and procedures:

• Between 2007 and 2013, MATHIEU was fraudulently owned by three of six medical clinics in Brooklyn ("Clinics"), all owned by co-conspirator Alexksandr Burman. During this period, Medicare and Medicaid clinics charged approximately $ 30 million for medical services and deliveries that were medically unnecessary and / or unavailable. During this period, MATHIEU constituted fraudulent as the owner of three of these clinics to meet a New York State Law requirement that medical clinics must be owned and operated by a medical professional.

• For the past three and a half years of the scheme, MATHIEU also participated directly in the clinics' fraudulent billing practices by visiting several of the clinics each week, writing under stacks of false and fraudulent medical charts and issuing references for expensive additional tests. , occupational therapy and physical therapy, including for physical therapy indicated provided by the defendant BEHIRY. During this time, MATHIEU did not see any patients at all without forging huge stacks of false medical records that incorrectly stated he had seen and treated such patients.

• BEHIRY also participated in the fraudulent billing practices of the clinics by pretending to provide physical therapy to many of the same patients, most of whom received cash shocks to get to the clinics. In fact, BEHIRY was engaged in an empty charade designed to create the appearance of physiotherapy, while almost no therapy was actually given to many patients. To promote fraud, BEHIRY also prepared and supervised the preparation of a large number of false medical and billing registers. Among other things, BEHIRY completed thousands of compiled reports, where patients are described almost identically and with little or no regard for current medical conditions or needs. As with MATHIEU, many of the charts for patients BEHIRY and his team had not evaluated or provided therapy at all.

• In addition to his role in the clinics, MATHIEU also wrote unnecessary recipes for adult diapers and other incontinence products that were filled at Universal Supply Depot, a medical supply company also owned by Burman's wife. MATHIEU was so diligent in this respect that throughout the fight against fraud, he was a regular prescriber of adult diapers in the state of New York. MATHIEU continued to write such prescriptions, even after the clinics were shut down because Medicare stopped paying any of the clinic's claims.

MATHIEU and BEHIRY include the number of defendants convicted in this and related cases. The other defendants include: Aleksandr Burman, 57, leader of the system, convicted in a related case on May 8, 2017, to 120 months in prison; Marina Burman, 56, Aleksandr Burman's former wife and the owner of Universal Supply Depot, was sentenced to 36 months in prison on May 17, 2018. Mustak Y. Vaid, 45, a doctor, was sentenced on August 1, 2018, to 18 months in prison; Ewald J. Antoine, 68, a doctor, was sentenced on August 21, 2018 to 18 months in prison. Asher Oleg Kataev, 50, a Burman business partner, was sentenced on May 31, 2018 to 36 months in prison; All Tsirlin, 49, a clinical office manager, was sentenced on June 5, 2018 to a year and a prison day; and Edward Miselevich, 46, and Ivan Voychak, 39, Burman partner who jointly operated a related ambulance company, were sentenced to 36 months in prison on July 12, 2018 and July 19, 2018, respectively. In addition, Lina Zhitnik, 52, and Dina Cabana Rubenstein, 39, occupational therapists, Valery Volsky, 60, a bookkeeper, Olga Kharuk, 47 and Natalya Grabovskaya, 48 office managers, also committed to their participation in this system and are waiting for judgment.

Wound physician convicted of fraudulently obtaining controlled substances

Dr. Paul Biddle, 54, Amherst, NY, convicted of identity theft and possession of illegal hydromorphone HCL, was sentenced to two years by US District Director Elizabeth A. Wolford.

Assistant US lawyer Michael J. Adler, who handled the case, stated that Biddle was an anesthetist and pain relief physician who also ran a medical marijuana exercise. Between February 9, 2015 and October 16, 2017, the defendant prescribed controlled subjects for two deceased patients. Biddle knew that the patients were deceased and used their names and birth dates consciously and without legal authority to obtain controlled subjects for themselves.

After a patient's death, Biddle 10 wrote prescriptions using the deceased patient's name and date of birth between November 21, 2016 and October 16, 2017. All these prescriptions were filled by a pharmacy in Tampa, FL and sent directly to the defendant's home or office. . After the second patient's death, the defendant wrote 23 prescriptions using the deceased patient's name and date of birth between February 9, 2015 and August 7, 2017. All of these recipes were also filled by a pharmacy in Tampa, FL and sent directly to the defendant's home or office. Biddle was getting these regulations and using them himself.

Owners of Opioid Addiction Treatment Practice are guilty of care fraud

Jennifer Hess, 50, blamed three counts for the United States District Judge Arthur J. Schwab. [19659009] Hess, a resident of Washington, PA, accused the federal court of allegations of helping and preventing illegal distribution of controlled substances and health fraud.
In connection with the guilty ground, the court advised that Hess founded and owned Redirections Treatment Advocates LLC (RTA), an opioid treatment practice with offices in Washington and Bridgeville, PA and Morgantown, Weirton and Moundsville, WVA. Hess helped and prevented the illegal distribution of buprenorphine, also known as Subutex and Suboxone, by filling in blank prescription recipes and / or forging doctors' names on blank recipes. Hess has also committed fraud prevention to cause fraudulent claims to be made to Medicaid and Medicare for payments to cover the costs of the illegally prescribed buprenorphine.

Judge Schwab scheduled the verdict for October 30, 2019 at 10 o'clock. The law provides for a total sentence of 30 years in prison, a fine of $ 1,250,000, or both. According to the federal conviction guidelines, the actual sanction is based on the gravity of the infringement and the previous criminal history, if any, of the defendant.

Virginia Man was sentenced to 19 months in prison for role in Medicare Fraud

Kenneth Johnson, 39, in Lorton, Virginia, has previously pleaded guilty to the US district director Anne E. Thompson for an information that charges him with a number of conspiracies for committing fraud prevention and a bill of conspiracy for improper access to individually identifiable information. [19659009] Ocean County Co-Defendant recently sentenced to 13 months in prison

Johnson, a Virginia man was sentenced 20 May 2019 to 19 months in prison for his role in a system using the alleged non-profit The good the Samaritans in America to deceive the Medicare program by over $ 525,000 by convincing hundreds of elderly to submit to genetic testing.

His co-persecutors also told previously guilty before Judge Thompson; Sheila Kahl, 47, of Ocean County, May 14, 2019 was sentenced to 13 months' imprisonment and Seth Rehfuss, 44, Somerset, New Jersey, was sentenced on May 10, 2019 to 50 months in prison.
Rehfuss used the good Samaritans in America to access groups of elderly people in various low-income residential complexes and convinced them to submit to genetic testing without any involvement of a health care professional. Contrary to what he told retirees and staff at the residential buildings, Rehfuss was the sales representative for laboratories, a fact he hid from his goals. To convince the elderly to submit to genetic testing, he used fear-based tactics during the presentations, including suggesting that the elderly would be vulnerable to heart attacks, strokes, cancer, and suicide if they did not have the genetic testing. [19659009] To get approved tests, Rehfuss used ads on Craigslist to recruit healthcare providers for the system. Healthcare providers were paid thousands of dollars a month by Rehfuss and others to sign their names on requisition forms that approved testing for patients they never examined or had any interaction with. Rehfuss and his conspirators, including Kahl and Johnson, created e-mail accounts, phone numbers, and built-up office manager names for the requisition forms that made it appear that caregivers were actually treating patients as swabbed and would be evaluating the test results.

Rehfuss, Kahl, Johnson and others caused the Medicare program to pay two clinical laboratories for the fraudulent test claiming that the system was generated. They got and shared more than $ 100,000 in commissions from the labs.
In addition to jail time, Judge Thompson Johnson sentenced three years of supervised release, ordering him to repay $ 525,000 and forfeit $ 525,000.
Podiatrist sentenced to prison for Medicare Fraud Scheme

Loren Wessel, 55, resident in Tucson, was convicted by the US District Judge James A. Soto for his role in a Medicare Fraud Prevention System. Wessel had previously pleaded guilty to medical failure.

From 2008 to June 2016, Wessel, a licensed podiatrist, was involved in a system to discourage Medicare from hundreds of thousands of dollars. In his appeal, Wessel admitted that he made false claims to Medicare. As part of his practice, Wessel regularly provided routine reception for patients with assistance opportunities in and around Tucson, but fraudulently billed Medicare for more complex and significantly more expensive services he had not performed. In order to further develop his system and hide the fraud, Wessel also documented false-documented patients' records with alleged diseases that they did not have and carefully gave Wessel.

In addition to serving a 24-month prison, Wessel's court was paying $ 965,985 in repayment to Centers for Medicare and Medicaid Services.

Other Insurance Fraud Convictions

Washington Man Pleads Guilty

Paul Albarella, Kennewick, pleaded guilty to Franklin County Superior Court to the first degree attempted theft. He will earn 20 days on a work crew and pay 500 kronor in court fees. He was charged in November 2018.

According to the survey, Albarella purchased a GEICO insurance policy for his 1996 Ford F-250 in April 2016. He filed an application in May and stated that the truck was damaged in a collision at a Pasco storage facility. GEICO valued the damage of $ 8.038. The company found documentation from the storage facility that the collision occurred the day before he bought the policy. GEICO denied the claim and referred the case to Kreeper's investigator.

Kreidler's CIU investigates insurance fraud and works with the Washington State Patrol and state and local prosecutors in criminal cases.

Ohio woman holds BWC benefits alive after Dad dies [19659019] Deborah Rosenlieb in Cuyahoga Falls, Ohio, committed the fourth degree of felony in Summit County Common Pleas Court, where a judge ordered her to pay BWC 29,418 dollars in repayment. The verdict also ordered Rosenlieb to serve two years of community service.
On May 9, Rosenlieb, an Northeast Ohio woman, committed to the workers' compensation fraud after investigators with the Ohio Bureau of Workers Compensation (BWC) found she collected her father's benefits for more than two years after he died.

"Ms. Rosenlie's father received death benefits on behalf of his late wife, but when her father died in January 2016, she did not know it," said BWC Administrator / CEO Stephanie McCloud. "She knew she was not entitled to these benefits. , but she used them for personal expenses until we learned from her order in April 2018. "

Guilty and 15 years of fraud taxation in the $ 1.7 million insurance system

Patrick Wayne Bronnon accused of conspiracy to commit mail fraud and the use of a fire in a field mission at a hearing before Judge Marcia A. Crone, of the US District Court of Texas in Texas.

Bronnon, a Texas man pleaded guilty to criminal charges arising from a 1.7-million program million dollars, where he acquired cheap real estate, burned or flooded the homes, and then accumulated major insurance damages on homeowners' policies, accused prosecutors e.

As part of his guilty reason, Bronnon has agreed to a 15-year jail term, said Joseph Brown, US Attorney for the Eastern District of Texas. But a final determination of the sentence is handed over to Crone, he says.

Bronnon, who was rebuilding and his cousin, Geraldine Weldon Joseph – along with 10 others – was accused last year by a large-scale jury of several insurance and postal fraud.

Joseph has a trial date set for July in Beaumont, Texas.

The defendants allegedly launched the system in 2011 on properties in the East Texas communities of Port Arthur, Port Neches, Beaumont and Sugarland. They exposed eight insurance companies, Allstate Insurance Co.; American Hallmark Insurance Co.; Geo Vera Specialty Insurance Co.; Homesite Insurance Co.; Progressive; Pronto insurance; Texas Farmers Insurance Co.; and Wellington Insurance Group, according to the charge.

According to the accusation, Bronnon and the co-conspirators bought cheap housing, received property protection and then injured the housing before claiming, accused prosecutors. On several occasions, the defendants were alleged to give the straw buyer access to the advance payment and the insurance premium. In total, there were nine fraudulent fire claims, three fraudulent water damage and two fraudulent theft damages considered by different insurance companies at nine different addresses.

Read full ZIFL, articleS and several judgments here.


© 2019 – Barry Zalma

This article and all the blog posts on this site, melt and summarize cases published by courts in the various states and the United States. The court decisions have been modified from the court's actual language, condensed to facilitate reading and convey the author's views in each individual case.

Barry Zalma, Esq., CFE now limits his practice to service as an insurance consultant specializing in insurance coverage, insurance management, bad faith assurance, and insurance fraud nearly equal for insurers and policyholders. He also serves as an arbitrator or mediator for insurance-related disputes. He practiced law in California for more than 44 years as an insurance cover and law firm and more than 50 years in the insurance industry. He is available at http://www.zalma.com and zalma@zalma.com.

Mr. Zalma is the first recipient of the first annual liability magazine / ACE Legend Award.

Over the past 51 years, Barry Zalma has put his life on insurance, insurance claims and the need to defeat insurance fraud. He has created the following library of books and other materials to enable insurers and their claims to become insurance managers.

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