The New Jersey Department of Labor and Workforce Development and the U.S Department of Labor pledged a historic new level of cooperation to protect New Jersey’s economy by signing an agreement on August 10, 2018 to work together to end illegal employee misclassification.
Showing posts with label fraud. Show all posts
Showing posts with label fraud. Show all posts
Wednesday, August 15, 2018
Saturday, February 10, 2018
Just Published: 2018 Update - Gelman on Workers' Compensation Law
Jon Gelman’s newly revised and updated 2018 treatise on Workers’ Compensation Law is now available from by West Group of Egan, MN within the next few weeks. The treatise is the most complete work available on NJ Workers’ Compensation law and integrated with WESTLAW™, the "most preferred online legal research service.'"
Thursday, December 21, 2017
Cries of High Costs and Fraud – Watch for Reforms
Today’s post comes from guest author Kit Case, from Causey Wright, Seattle, Washington..
There is always discussion, in every state, about the expense of workers’ compensation insurance to employers. It is common to hear stories of corruption and fraud when employer costs run high. This discussion can lead to cries of fraud, usually with fingers pointed towards claimants and often tied into efforts to reduce benefits to injured workers. As a recent example, take a look at the article published on July 23rd in the Fresno Bee, written by Dan Walters of CALmatters, titled “California workers’ compensation system plagued by high costs and fraud.” In the article, Mr. Walters points to Southern California as an area particularly afflicted by fraud, inserting the hot-button phrase “immigrant workers,” as follows:
There is always discussion, in every state, about the expense of workers’ compensation insurance to employers. It is common to hear stories of corruption and fraud when employer costs run high. This discussion can lead to cries of fraud, usually with fingers pointed towards claimants and often tied into efforts to reduce benefits to injured workers. As a recent example, take a look at the article published on July 23rd in the Fresno Bee, written by Dan Walters of CALmatters, titled “California workers’ compensation system plagued by high costs and fraud.” In the article, Mr. Walters points to Southern California as an area particularly afflicted by fraud, inserting the hot-button phrase “immigrant workers,” as follows:
Monday, June 5, 2017
Chaos for Workers' Compensation Programs--The Elimination of Social Security Numbers?
Wednesday, August 26, 2015
Federal Court Civil Action Stayed Pending Criminal Case
A civil action instituted by LM Insurance Corporation was stayed against a defendant employer pending a Federal criminal action. The application to stay the Federal civil action was made by the employer to the court following the issuance of multiple Grand Jury Subpoenas and the execution of a Search and Seizure Warrant against the defendant employer in his home and place of business.
Monday, August 18, 2014
California Medical Fraud Investigation Continues
"Follow the money." The investigation of fraud in the California Workers' Compensation system continues. Today's post of Julius Young of the California Bar
is shared from workerscompzone.com
You might have thought that news of bad behavior in California’s workers’ comp system was hitting bottom.
After all, could it get worse? Allegations of legislators taking money to help charlatans who profited off of the backs of injured workers (literally). Scads of doctors alleged to have taken kickbacks for prescribing questionable compound medicines one of which allegedly killed a baby.
It appears that law enforcement authorities are now focusing on relationships between some applicant attorney firms and medical groups.
In Southern California the Riverside County DA has executed a search warrant against a workers’ comp firm, California Injury Lawyers (CIL). Apparently this is a result of a long investigation into suspected workers’ comp fraud, targeting operations allegedly connected to an individual named Peyman Heidary who is said to have a financial interest in as many as nine medical clinics in the Los Angeles area.
The details of the alleged bad behavior or fraud is unclear, and it must be noted that any allegations are currently just that, allegations.
[Click here to read more]
You might have thought that news of bad behavior in California’s workers’ comp system was hitting bottom.
After all, could it get worse? Allegations of legislators taking money to help charlatans who profited off of the backs of injured workers (literally). Scads of doctors alleged to have taken kickbacks for prescribing questionable compound medicines one of which allegedly killed a baby.
It appears that law enforcement authorities are now focusing on relationships between some applicant attorney firms and medical groups.
In Southern California the Riverside County DA has executed a search warrant against a workers’ comp firm, California Injury Lawyers (CIL). Apparently this is a result of a long investigation into suspected workers’ comp fraud, targeting operations allegedly connected to an individual named Peyman Heidary who is said to have a financial interest in as many as nine medical clinics in the Los Angeles area.
The details of the alleged bad behavior or fraud is unclear, and it must be noted that any allegations are currently just that, allegations.
[Click here to read more]
Friday, June 27, 2014
Facebook Required to Turn Over User Information in Disability-Fraud Investigation
| Today's ppost was shared from http://online.wsj.com The Manhattan district attorney has won a legal battle against Facebook Inc. with a New York judge's ruling that the social network was required to turn over user information in a fraud investigation. When workers who filed for federal disability money were seen on Facebook looking perfectly healthy, the Manhattan district attorney received a search warrant from a judge to look more closely at the accounts. Facebook had attempted to quash the warrants for 381 user accounts on grounds that they were unconstitutional and in violation of Fourth Amendment protections against unreasonable searches and seizures. After reviewing the search-warrant application, the judge found "probable cause that evidence of criminality would be found within the subject Facebook accounts," and ordered Facebook to comply. “Due to the fungible nature of digital information, the ability of a user to delete information instantly and other possible consequences of disclosure, the court ordered the search warrants sealed and Facebook not to disclose the search and seizure to its users.”—Melissa C. Jackson, New York State Supreme Court Justice The district attorney's office said the case led to 134 indictments on more than $400 million in fraud, and that half the defendants have pleaded guilty. "This was a massive scheme involving as many as 1,000 people who defrauded the federal government," said Joan Vollero, spokeswoman for Manhattan District Attorney Cyrus Vance. "The defendants in this case repeatedly lied to the government about their mental, physical, and social capabilities. Their Facebook accounts told a different story," she said. The judge in the case said Facebook had no right to get in the way of the investigation. "Facebook could best be... |
[Click here to VIEW the documents in this case (NYTime)]
Monday, June 16, 2014
Undocumented Aliens Ensnared By Workers' Compensation
Peter Rousmaniere comments today about the problems, threats and fears that undocumented aliens confront with the nation's patchwork of compensation programs. Injured undocumented aliens in states than mandate the submission of a social security number to file an initial application for workers' compensation benefits are particular targets for criminal fraud enforcement.
"The eight million undocumented workers comprise about 6% of the total civilian workforce. By studying estimates of undocumented worker penetration by occupations ranked by injury risk, one can reasonably project that undocumented workers sustain one out of every ten work injuries. This high volume is invisible to almost everyone except for adjusters, case managers, lawyers and others who work directly with injured workers and have learned their work and life patterns. The rate varies greatly, from maybe 2% in West Virginia, a low foreign-born population state, to over half within the fruit and vegetable producing counties of southern California."
Reconciliation of this issue remains uncertain for a multitude of reasons. The future of immediate national reform of immigration laws this election cycle now looks bleak with Eric Cantor's recent primary defeat. States will continue to use Social Security information for tax collection and enforcement, in addition to the reconciliation of other programs such as Medicare and unemployment benefits.
Ironically as Rousmaniere points out in his commentary, the power of the employer over the employee, is a huge challenge to the improvement of safety and health in the workplace. Shifting the burden from employers to US taxpayers is problematic. As the Affordable Care Act is fined tuned in the years ahead, the issue of undocumented aliens will become both a more dominate moral and legal issue in need of reform.
Tuesday, February 25, 2014
Throw The Book At 'Em
There seems to be no limit in the amount of fraudulent conduct that transpires within the workers' compensation system. If employer fraud is not enough, the system is constantly undergoing abuse from business interests, ie. medical provo\iders, who abuse the system. The Federal Governments role in enforcement is ever increasing and expansion is trending wider. The gobal expanssion nationally of a universal program for monitoring and enforcement of medical fraud is encouraging. Today's post is shared from David DePaolo http://daviddepaolo.blogspot.com/
It's a shame that hundreds, if not thousands, of injured workers underwent unnecessary spinal fusion surgeries and must live with the debilitating aftermath of significant disability because of people whose greed overrides the well being of fellow humans.
I had learned about Michael Drobot and Pacific Hospital of Long Beach, and their co-conspirators, preying on workers' compensation patients some time ago.
On Friday though, Federal prosecutors announced that Michael D. Drobot faces up to 10 years in prison after he pleaded guilty to paying kickbacks in a $500 million fraud scheme relating to spinal fusions and admitted to bribing state Sen. Ron Calderon to delay legislation to repeal the separate reimbursement for spinal hardware.
Calderon, D-Montebello, was indicted one day earlier on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. His brother, former...
[Click here to see the rest of this post]
Related articles
California state Sen. Ron Calderon accepted $88,000 in bribes, FBI affidavit alleges (workers-compensation.blogspot.com)
IMR: DWC Get Out of the Way (workers-compensation.blogspot.com)
One Claim Going OTOC (workers-compensation.blogspot.com)
Work Comp Lost Focus (workers-compensation.blogspot.com)
OK's True Cost Control Feature (workers-compensation.blogspot.com)
The Conflict Between NAFTA and Comp (workers-compensation.blogspot.com)
Being Professional (workers-compensation.blogspot.com)
Read more about "Federalization of Workers' Compensation"
It's a shame that hundreds, if not thousands, of injured workers underwent unnecessary spinal fusion surgeries and must live with the debilitating aftermath of significant disability because of people whose greed overrides the well being of fellow humans.
I had learned about Michael Drobot and Pacific Hospital of Long Beach, and their co-conspirators, preying on workers' compensation patients some time ago.
On Friday though, Federal prosecutors announced that Michael D. Drobot faces up to 10 years in prison after he pleaded guilty to paying kickbacks in a $500 million fraud scheme relating to spinal fusions and admitted to bribing state Sen. Ron Calderon to delay legislation to repeal the separate reimbursement for spinal hardware.
Calderon, D-Montebello, was indicted one day earlier on 24 charges, including bribery, money laundering, wire fraud and filing a false tax return. His brother, former...
[Click here to see the rest of this post]
Related articles
California state Sen. Ron Calderon accepted $88,000 in bribes, FBI affidavit alleges (workers-compensation.blogspot.com)
IMR: DWC Get Out of the Way (workers-compensation.blogspot.com)
One Claim Going OTOC (workers-compensation.blogspot.com)
Work Comp Lost Focus (workers-compensation.blogspot.com)
OK's True Cost Control Feature (workers-compensation.blogspot.com)
The Conflict Between NAFTA and Comp (workers-compensation.blogspot.com)
Being Professional (workers-compensation.blogspot.com)
Read more about "Federalization of Workers' Compensation"
Jul 05, 2012
United States Supreme Court has taken a giant leap forward to facilitate the Federalization of the entire nation's workers' compensation system. By it's recent decision, upholding the mandate for insurance care under the ...
Dec 23, 2010
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally ...
Jul 05, 2010
The trend toward Federalization of workers' compensation benefits took a giant step forward by recent Presidential action creating the British Petroleum Oil Compensation Fund. While the details remain vague, the broad and ...
Jun 14, 2012
Yesterday the US Congress passed and sent to the President, The World Trade Center Health Program, marking yet another advance on the path to federalize the nation's workers' compensation program. The Federally .
Saturday, December 21, 2013
Employer Fraud: NJ employer accused of stealing over $265K from workers' comp insurer
 |
| Charles Kelcy Pegler Sr. |
TRENTON — Charles Kelcy Pegler Sr., 55, of Spring Lake, has been indicted for stealing more than $265,000 by providing false and misleading information to the workers compensation insurance carrier for his roofing company.
Pegler was charged Thursday with second-degree theft by deception, second-degree false contract payment claim for a government contract, third-degree insurance fraud and fourth-degree false swearing, the state Attorney Generals Office announced. Pegler is the president of Roof Diagnostics Inc. located at 2333 Route 34 in Wall. During the time described by the indictment, the company was at 608 Brighton Ave. in Spring Lake Heights. The indictment alleges that between June 6, 2002 and Oct. 5, 2009, Pegler stole $265,044 from New Jersey Casualty Insurance Co. by creating the false impression that Roof Diagnostics was not a roofing company, that it did not employ roofers and that it did not install, maintain or repair roofs. That meant he paid far less in insurance premiums than he should have, according to state investigators. This defendant had a legal responsibility to provide adequate and lawful workers compensation coverage for employees, Acting Attorney General John J. Hoffman said in a release. By providing misinformation to his workers compensation carrier, he not only failed in this responsibility but also defrauded an insurance company out of hundreds of thousands of dollars. The cost of such fraud is passed... |
Friday, November 15, 2013
Blowing the Whistle on the Chamber of Commerce
The U.S. Chamber of Commerce’s Institute for Legal Reform recently released a report on the False Claims Act (FCA)—the primary whistleblower legislation utilized by the federal government. Unfortunately, its analysis presents a fundamentally defective approach to addressing fraud in business.
In short, the Chamber’s report concludes the following: there is a lot of fraud in American commerce, particularly the kind of fraud (much of it in healthcare) that costs American taxpayers billions and billions of dollars annually (in excess of $70 billion according to the Government Accountability Office). In fact, fraud is such a big problem that Congress needs to amend the FCA and reduce protections and rewards available for those who risk their careers to report that fraud. The reality is that the FCA is an example of how the government works at its best and most efficient. In fact, another recent study by the Taxpayers Against Fraud Education Fund concludes that the government actually recovers $20 for every $1 it invests in fraud investigations pursuant to the FCA. And there is a reason for it. It is because it may be the one area where government appropriately harnesses the private sector profit motive. It is the one area where government outsources ordinary people, driven by their own morality, conscience, and, yes, desire for money, to help do government’s work and provide a public good in the process. In fact, some... |
Wednesday, October 9, 2013
NJ Police Officer Indicted for Misclassification and Workers' Compensation Fraud
Today's post was shared from www.trentonian.com
[Click here to see the rest of this post]
A Trenton police officer and his father were indicted last week on charges of false swearing and workers compensation fraud.
Trenton Police officer Gaetano Ponticiello, 42, and his father Filippo Ponticiello, 65, were indicted last week by a Mercer County grand jury on fourth-degree charges of false swearing and workers compensation fraud. Each offense carries a maximum penalty of 18 months in prison and a $10,000 fine. According to prosecutors in the case, on Feb. 23, 2009, both Gaetano and Filippo made false statements under oath regarding workers compensation claims. Prosecutors say the false or misleading statements included a misclassification of employees for the purpose of evading the full payment of benefits or premiums. Both father and son are scheduled to appear in Mercer County Superior Court Oct. 25. Gaetano Ponticiello has been with the Trenton Police Department for at least 15 years. Lt. James Slack of the Trenton Police Department internal affairs told The Trentonian in July that Ponticiello has been suspended without pay. |
Saturday, October 5, 2013
New York Second in Nation for Questionable Workers’ Compensation Claims
| New York State is second in the nation, only behind California, for questionable workers’ compensation insurance claims. The Empire State jumped to the second place in 2012 from fifth in 2011, the New York Insurance Association noted. “Workers compensation insurance fraud is a serious problem in New York,” Ellen Melchionni, president of the New York Insurance Association, said. “Fraud drives up workers compensation rates. The state and insurance industry need to remain vigilant in cracking down on those looking to cheat the system.” The National Insurance Crime Bureau (NICB) analysis shows that the number of New York’s questionable claims reported in 2012 was more than double the questionable claims reported in 2011. There were 344 reported in 2012 versus 161 in 2011. The NICB analysis also shows that in New York State, questionable claims in 2013 are on pace to exceed the 2012 figure. According to data available for the first half of 2013, 183 questionable claims were reported in the state between January and June. “The growing rate of questionable workers compensation claims is alarming,” Melchionni said. “Fraud takes away from workers compensation serving its intended purpose of protecting injured workers.” Source: The New York Insurance Association |
Monday, May 13, 2013
The Attack on the Citadel: A Potential National Loss
Workers’ Compensation is conceptually changing, and its
extinction is becoming more apparent rather than its transformation. Over the
past decades, the “grand bargain” of Workers’ Compensation had evolved to ease the American industrial/manufacturing revolution forward, without burden from the economic complexities and
ramifications of the Civil Justice System.
“The Promise” made in 1911, with the adoption of the compensation system, is now past history. The demands
of the globalized marketplace have eroded the fortress of workers’ compensation that
protected the rights, safety and lives of American workers.
“The Promise” made in 1911, with the adoption of the compensation system, is now past history. The demands
of the globalized marketplace have eroded the fortress of workers’ compensation that
protected the rights, safety and lives of American workers.
Dynamic developments, occurring at an ever increasing pace, have altered
the landscape and accelerated a devastating attack on the citadel of
workers’ compensation. The root of the cause is economic.
Saturday, April 20, 2013
Employer Fraud: Safety Manager Conceals Employee Injuries for Bonus
On Apr. 11, 2013, Walter Cardin, 55, of Metairie, La., was sentenced to serve 78 months in prison followed by two years of supervised release, by the Honorable Curtis L. Collier, U.S. District Judge. Cardin was convicted at trial in November 2012, after being charged by a federal grand jury with eight counts of major fraud against the Tennessee Valley Authority (TVA), an agency of the United States.
The indictment and subsequent conviction of Cardin was the result of a six-year
The Shaw Group had a contract with TVA to provide maintenance and modifications to the three facilities and to provide construction for the Brown’s Ferry Unit Number 1 reactor restart. Cardin generated false injury rates which were used by the Shaw Group to collect safety bonuses of over $2.5 million from TVA. As part of a civil agreement filed with the United States in 2008, the Shaw Group paid back twice the amount of the ill-gotten safety bonuses.
Saturday, March 23, 2013
The Going and Coming Rule: Parking Lot Injury Held Not Compensable
A NJ appellate court ruled that an employee who was severely injured in a parking lot as a result of a slip and fall was not entitled to workers’ compensation benefits since the injury occurred “off the premises” and the employer did not control the employee’s parking.
The Court also ruled, that even though a separate corporation that owned the parking lot, the corporate veil could not be pierced in absence of the proof of fraud by the employer. The employer merely rented the store premises and not the parking lot.
Cottone v Medical Supply Corp. and NJ Manufacturers (Intervener)
2013 WL 1136114 (N.J.Super.A.D.) Decided March 20, 2013
Sunday, December 9, 2012
Insurance Company Broker Caught Cooking the Books
NJ Attorney General Jeffrey S. Chiesa announced that an employee of a former Morris County insurance brokerage company pleaded guilty today to stealing several million dollars entrusted to her employer. These funds had been entrusted to the insurance brokerage for the purpose of purchasing insurance policies for small and medium-sized businesses in New Jersey and New York.
Kelly Roetto, 45, of Bedminster, pleaded guilty to an accusation charging her with second-degree theft by unlawful taking, second-degree issuing bad checks, and second-degree misconduct by a corporate official before Superior Court Judge Thomas V. Manahan in Morris County.
Judge Manahan scheduled sentencing for Dec. 19.Under the plea agreement, the state will recommend that Roetto be sentenced to nine years in state prison. In addition, Roetto will be ordered to pay restitution and will agree to never again obtain an insurance license in the State of New Jersey.
“This defendant used her position of trust within this insurance brokerage firm to divert millions of dollars,” Attorney General Chiesa said. “My office will continue to work with the insurance industry to root out corrupt insurance brokers.”
“This crime attacked the integrity of our insurance system by deceiving both companies seeking insurance and companies that finance such insurance,” Acting Insurance Fraud Prosecutor Ronald Chillemi said. “Such crimes warrant vigorous prosecution and serious sanctions.”
At the time of the crime, Roetto was the controller for a now-defunct insurance brokerage called the John A. Rocco Co., Inc. (JarCo), located in Florham Park. JarCo was in the business of obtaining insurance policies on behalf of small and medium-sized trucking, hauling, waste management, moving, and recycling businesses located in New Jersey and New York. As part of its operations, JarCo would arrange for these businesses to finance the cost of such insurance policies, and used its existing relationships with numerous premium finance companies for this purpose. In her capacity as the Controller for JarCo, Roetto was responsible for arranging this financing and for ensuring that the borrowed funds were forwarded from JarCo’s bank accounts to the insurance carriers or their respective agents.
In pleading guilty, Roetto admitted that between January 1, 2008 and May 28, 2010, she used her position as JarCo’s controller to steal between $3,800,000 and $5,000,000 of financed proceeds. The state’s investigation revealed that Roetto was able to perpetrate these offenses by capitalizing on the complexity of the premium finance transaction process using a combination of different schemes. For example, Roetto admitted that she knew that these finance companies sent financed proceeds to JarCo with the understanding that they would be used to purchase insurance policies on behalf of businesses seeking coverage. She further admitted that on numerous occasions she failed to send this money to the carriers and, instead, exercised unlawful control over such money by using it for a purpose other than its intended purpose.
Roetto also admitted that she caused unauthorized finance agreements to be submitted to these finance companies and that she used the proceeds obtained in connection with these unauthorized agreements for unlawful purposes. In addition, Roetto admitted that she used her position to issue more than 200 bad checks totaling more than $2,000,000. These checks were drawn on many of JarCo’s bank accounts at not fewer than 10 banks.
Read More About Insurance Company/Employer Fraud
Kelly Roetto, 45, of Bedminster, pleaded guilty to an accusation charging her with second-degree theft by unlawful taking, second-degree issuing bad checks, and second-degree misconduct by a corporate official before Superior Court Judge Thomas V. Manahan in Morris County.
Judge Manahan scheduled sentencing for Dec. 19.Under the plea agreement, the state will recommend that Roetto be sentenced to nine years in state prison. In addition, Roetto will be ordered to pay restitution and will agree to never again obtain an insurance license in the State of New Jersey.
“This defendant used her position of trust within this insurance brokerage firm to divert millions of dollars,” Attorney General Chiesa said. “My office will continue to work with the insurance industry to root out corrupt insurance brokers.”
“This crime attacked the integrity of our insurance system by deceiving both companies seeking insurance and companies that finance such insurance,” Acting Insurance Fraud Prosecutor Ronald Chillemi said. “Such crimes warrant vigorous prosecution and serious sanctions.”
At the time of the crime, Roetto was the controller for a now-defunct insurance brokerage called the John A. Rocco Co., Inc. (JarCo), located in Florham Park. JarCo was in the business of obtaining insurance policies on behalf of small and medium-sized trucking, hauling, waste management, moving, and recycling businesses located in New Jersey and New York. As part of its operations, JarCo would arrange for these businesses to finance the cost of such insurance policies, and used its existing relationships with numerous premium finance companies for this purpose. In her capacity as the Controller for JarCo, Roetto was responsible for arranging this financing and for ensuring that the borrowed funds were forwarded from JarCo’s bank accounts to the insurance carriers or their respective agents.
In pleading guilty, Roetto admitted that between January 1, 2008 and May 28, 2010, she used her position as JarCo’s controller to steal between $3,800,000 and $5,000,000 of financed proceeds. The state’s investigation revealed that Roetto was able to perpetrate these offenses by capitalizing on the complexity of the premium finance transaction process using a combination of different schemes. For example, Roetto admitted that she knew that these finance companies sent financed proceeds to JarCo with the understanding that they would be used to purchase insurance policies on behalf of businesses seeking coverage. She further admitted that on numerous occasions she failed to send this money to the carriers and, instead, exercised unlawful control over such money by using it for a purpose other than its intended purpose.
Roetto also admitted that she caused unauthorized finance agreements to be submitted to these finance companies and that she used the proceeds obtained in connection with these unauthorized agreements for unlawful purposes. In addition, Roetto admitted that she used her position to issue more than 200 bad checks totaling more than $2,000,000. These checks were drawn on many of JarCo’s bank accounts at not fewer than 10 banks.
Read More About Insurance Company/Employer Fraud
Jul 12, 2012
Corporate Workers Compensation Fraud: California Targets Underground Economy. Sweep targets contractors operating in California's underground economy. Insurance Commissioner Dave Jones today announced that a ...
Apr 11, 2011
Perception is reality until proven otherwise, and when it comes to fraud in the workers' compensation system there is the perception that employee fraud is widespread and costs are up because of employee fraud. Could that ...
Mar 04, 2012
Premium Fraud: North Carolina Man Sentenced on Workers' Compensation Insurance Scam. English: The Seal of the United States Federal... Image via Wikipedia. Wifredo A. Ferrer, United States Attorney for the Southern ...
Apr 14, 2011
In recent testimony before the US House of Representatives' Committee on Oversight and Government Reform, David C. Williams, Inspector General of the US Postal Service, reported widespread fraud in the system, and with ...
Monday, October 24, 2011
Insurance Agent Charged With Theft of $255,000 of Work Comp Premiums
Attorney General Linda Kelly identified the defendant as Joseph A. Maurer, 58, of 2558 Welsh Road, Mohnton. Maurer owned and operated Commonwealth Professional Group, a former insurance agency located in Reading, Berks County.
According to the criminal complaint, Maurer is accused of taking more than $188,000 in premiums paid by four municipal governments, including Bally Borough and South Heidelberg Township, located in Berks County, along with Salisbury Township in Lehigh County and Earl Township in Lancaster County. The money allegedly paid to Maurer by all four municipalities was supposed to be forwarded to Pennprime Insurance Trust, of Harrisburg, as payment for workers compensation coverage.
Additionally, Maurer allegedly misdirected premium payments for at least five other policies purchased through his agency, totaling in excess of $67,000 that was supposed to be forwarded to Travelers Insurance and ACE American Insurance Company on behalf of various clients.
Maurer is charged with three counts of theft by failure to make required disposition of funds received, all third-degree felonies which are each punishable by up to seven years in prison and $15,000 fines.
Maurer was preliminarily arraigned on October 12th before Reading Magisterial District Judge Phyllis J. Kowalski and released on $850,000 unsecured bail. He was also ordered to surrender his passport.
A preliminary hearing for Maurer is scheduled for November 9th, at 1:30 p.m., before Magisterial District Judge Kowalski.
The case will be prosecuted in Berks County by Deputy Attorney General John T. Dickinson of the Pennsylvania Attorney General's Insurance Fraud Section.
Saturday, July 2, 2011
Injured Worker Sues Insurance Company for Malicious Prosecution
"In this proceeding we consider the appeal of AIG Domestic Claims, Inc. (AIGDC), from the denial of its motion for summary judgment. Jesse Maxwell, a workers' compensation claimant, brought suit against AIGDC regarding the company's conduct in referring his claim to the insurance fraud bureau (IFB), communicating with fraud investigators and prosecutors regarding his activity and claim, and using criminal processes to gain leverage in dealings with him. Maxwell sought recovery on theories of malicious prosecution, infliction of emotional distress, abuse of process, and violation of G.L. c. 93A and G.L. c. 176D. In July, 2007, AIGDC filed a special motion to dismiss the suit pursuant to G.L. c. 231, § 59H, the so-called “anti-SLAPP” statute. That motion was denied and AIGDC's appeal was unsuccessful. See Maxwell v. AIG Domestic Claims, Inc., 72 Mass.App.Ct. 685, 893 N.E.2d 791 (2008). On remand, the parties conducted discovery and AIGDC filed a motion for summary judgment in August, 2009. Summary judgment was denied. AIGDC appealed under the doctrine of present execution, and we granted its application for direct appellate review.
"We conclude that AIGDC enjoys qualified immunity regarding its reporting of potentially fraudulent activity but that summary judgment is inappropriate because all of Maxwell's claims rely, at least in part, on conduct falling outside the scope of the immunity. We also conclude that portions of Maxwell's claims may be barred by workers' compensation exclusivity under G.L. c. 152, but that not one of Maxwell's counts is barred entirely such that the Superior Court would be without subject matter jurisdiction. Accordingly, we affirm the order of the Superior Court denying summary judgment and remand the case for further proceedings consistent with this opinion.
For over 3 decades the Law Offices of Jon L. Gelman 1.973.696.7900 jon@gelmans.com have been representing injured workers and their families who have suffered occupational accidents and illnesses.
Thursday, April 14, 2011
Playing the Fraud Card - The Boat Named Free Ride
In recent testimony before the US House of Representatives' Committee on Oversight and Government Reform, David C. Williams, Inspector General of the US Postal Service, reported widespread fraud in the system, and with an entourage of others, urged "significant reform" of the Federal Employees Compensation Act (FECA) Program.
He said, "The Postal Service is the largest FECA participant, paying more than $1 billion in benefits and $60 million in administrative fees annually, creating a long-term liability of $12.6 billion. As of February 2011, the Postal Service had about 15,800 disabled employees. Over 8,700 were at least age 55, about 3,100 were at least age 65, and about 900 were between age 80 and 98. "
"...Since October 2008, we have removed 476 claimants based on disability fraud, recovered $83.5 million in medical and disability judgments, and halted significant future losses. In one investigation, a fraudulent claimant received $142,000 in benefits while she was working as a real estate agent, and we had pictures of her hiking and bungee jumping. She even bought a boat named “Free Ride.” Other investigations have found fraudulent claimants working as martial arts instructors, landscapers, hairdressers and mechanics."
He said, "The Postal Service is the largest FECA participant, paying more than $1 billion in benefits and $60 million in administrative fees annually, creating a long-term liability of $12.6 billion. As of February 2011, the Postal Service had about 15,800 disabled employees. Over 8,700 were at least age 55, about 3,100 were at least age 65, and about 900 were between age 80 and 98. "
"...Since October 2008, we have removed 476 claimants based on disability fraud, recovered $83.5 million in medical and disability judgments, and halted significant future losses. In one investigation, a fraudulent claimant received $142,000 in benefits while she was working as a real estate agent, and we had pictures of her hiking and bungee jumping. She even bought a boat named “Free Ride.” Other investigations have found fraudulent claimants working as martial arts instructors, landscapers, hairdressers and mechanics."
What is really sad is that the plot is aways the same. When the budget needs to be balance, the target unfortunately becomes those who are compromised and limited in ability to defend themselves, the injured worker. There is always a bad sailor on the ship, but there is no need to have everyone walk the plank. Agreed that the system is 95 years old and doesn't function efficiently, as is mirrored other jurisdictions. The fraud card is merely an excuse and not a remedy. Maybe it is time for a new approach entirely to help injured workers by resolving the medical delivery problems and creating a unified and universal Federal approach.
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