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Showing posts with label Plea. Show all posts
Showing posts with label Plea. Show all posts

Monday, April 21, 2014

President of Roofing Company Pleads Guilty to Felony for Scheme to Avoid Paying Hundreds of Thousands of Dollars in Insurance Premiums

Acting NJ Attorney General John J. Hoffman announced that the president of a roofing company pleaded guilty today to providing false and misleading information to the company’s workers’ compensation insurance carrier in order to avoid paying hundreds of thousands of dollars in insurance premiums that he was obligated to pay.

Charles Kelcy Pegler Sr., 56, of Spring Lake, pleaded guilty to third-degree insurance fraud before Superior Court Judge Anthony J. Mellaci in Monmouth County. Pegler was charged in a Dec. 19, 2013 state grand jury indictment.

Judge Mellaci scheduled sentencing for June 6. Under the plea agreement, the state will recommend that Pegler be sentenced to 180 days in county jail as a condition of five years of probation. Pegler previously paid full restitution to New Jersey Manufacturers Insurance Company. The plea agreement also requires Pegler to pay $134,087 to Atain Insurance Company.

“Employers have an obligation to provide full and adequate workers compensation insurance coverage for their employees,” Acting Attorney General Hoffman said. “Because of criminals such as this defendant, honest, hard-working New Jerseyans are forced to pay increased premiums to cover the costs of the fraud.”

“This conviction demonstrates that the Office of the Insurance Fraud Prosecutor stands ready and able to prosecute sophisticated schemes and influential executives, even those at the highest reaches of companies,” Acting Insurance Fraud Prosecutor Ronald Chillemi said.

Pegler was the president of Roof Diagnostics, Inc. (“RDI”), which was located at 2333 Highway 34 in Wall. During the time of the alleged crime, RDI was located at 608 Brighton Avenue in Spring Lake Heights. RDI employs approximately 400 people. In pleading guilty, Pegler admitted that between June 11, 2003 and Oct. 5, 2009, he created the false impression to New Jersey Casualty Insurance Company, which is a subsidiary of New Jersey Manufacturers Insurance Company, that RDI was not a roofing company, that it did not employ roofers and that it did not install, maintain and/or repair roofs. An investigation by the Office of the Insurance Fraud Prosecutor determined that, as a result of the alleged crime, RDI paid $265,044 less in workers’ compensation insurance premiums than it should have.

Pegler further admitted that between Jan. 15 and Dec. 9, 2009, he created the false impression to USF Insurance Company, now called Atain Insurance Company, that all roofing and re-roofing services offered by RDI were performed by subcontractors. Through this fraud, Pegler avoided paying $134,087 in general liability insurance premiums which he owed to the insurance company.

Acting Insurance Fraud Prosecutor Chillemi, Deputy Attorneys General Michael Locke, Bradford Muller and Thomas Tresansky and Detective Natalie Brotherston coordinated the investigation. Acting Insurance Fraud Prosecutor Chillemi represented the state at the guilty plea hearing. Additional investigative assistance was provided by Detective Taryn Kong and Detective Trainee Ryan Kirsh, Analysts Terry Worthington and Terri Drumm and Technical Assistant Ramona Navarro. Acting Insurance Fraud Prosecutor Chillemi thanked the New Jersey Department of Labor and Workforce Development, New Jersey Manufacturers Insurance Company and Atain Insurance Company for their assistance in the investigation.

Saturday, January 11, 2014

Former Texas Workers' Compensation Director Pleads Guilty to $500,000 Fraud

Former Texas Association Of School Boards (TASB) Workers Compensation Claims Administration Director Pleads Guilty To Mail Fraud Charges

In Austin today, Herman G. Wilks, former Department Director of Workers’ Compensation Claims Administration for the Texas Association of School Boards, Inc. (TASB), pleaded guilty to stealing over $500,000 from the TASB’s Risk Management Fund announced United States Attorney Robert Pitman and Federal Bureau of Investigation Special Agent in Charge Armando Fernandez, San Antonio Division.

The TASB is a voluntary, non-profit, statewide educational association that serves and represents local Texas school districts, regional education service centers, community colleges, and tax appraisal districts. One of the products and services offered by TASB to its members is the TASB Risk Management Fund. The TASB Risk Management Fund provides specific coverage to members through their requisite financial contributions into the risk management pool. This coverage can then apply with regard to unemployment compensation claims, workers' compensation claims, auto, liability and property programs. Wilks’ TASB duties included the supervision of setting up member school districts' workers' compensation claims, adjudicating medical bills and carrying out the utilization, management and pre-authorization functions required by the workers' compensation statutes. Pursuant to his title and area of responsibility at TASB, Wilks had control over and direct access to the entire claimant pay process by which TASB accepted and paid workers' compensation claims for its contributing members by way of the TASB Risk Management Fund.

Appearing before U.S. District Judge Sam Sparks this morning, Wilks pleaded guilty to ten counts of mail fraud. By pleading guilty, Wilks admitted that from April 2008 until March 2013, he unlawfully obtained approximately $514,400 from TASB via the TASB Risk Management Fund by submitting fraudulent workers’ compensation claims on behalf of Medco Implantable Supply, a company he created for the sole purpose of carrying out his fraudulent scheme, for products and services that were never actually ordered, provided or rendered.

“Like many defendants, Mr. Wilks undoubtedly concocted his scheme of setting up a dummy company to steal hundreds of thousands of dollars from the TASB Risk Management Fund with full confidence that he would get away with it. This prosecution should remind would-be thieves like Mr. Wilks that their schemes will be discovered and they will lose not only their ill-gotten gain, but their livelihoods, reputations and quite likely their freedom as a result,” stated U.S. Attorney Pitman.

Wilks faces up to 20 years in federal prison per count. He is currently out on bond pending sentencing which has yet to be scheduled.

This indictment resulted from an investigation conducted by the Federal Bureau of Investigation. Assistant United States Attorney Ashley Hoff is prosecuting this case on behalf of the Government
.