Plus a renewed crime-fighting partnership
State fraud investigators working with local law enforcement have made more arrests in their ongoing crackdown on unlicensed contractors; a Miami woman has been convicted in a $34 million healthcare fraud against insurance companies; and two giants in the analytics and crime business are renewing their partnership. It’s all in this week’s look at fraud news.
Unlicensed Contractors: The Florida Department of Financial Services (DFS) last week announced the arrest of 13 unlicensed contractors in Pasco County. It was part of a sting with the local sheriff’s office and the National Insurance Crime Bureau. The 13 individuals were booked on charges that include Failure to Obtain Workers’ Compensation Coverage and Unlicensed Contracting. It comes on the heels of an operation in Manatee County that resulted in eight similar arrests.
Physical Therapy Fraud: A federal jury in Miami this month convicted Jaroslava Ruiz of health care and wire fraud. She was part of a scheme that paid kickbacks and bribes to patient recruiters and to patients with private insurance in order to bill their insurance companies for physical therapy services that never happened at four Miami-area clinics she managed. Among the victims were Blue Cross Blue Shield, Cigna and United Health Group, who paid nearly $8 million of the $34.6 million they were billed for services from 2016 to 2020. Police are still looking for her boss, Jesus Porras, who operated Ramirez Rehab Center, Long Life Medical Services, AA Ortiz Medical Center and Perez Medical Center. Ruiz faces more than 30 years in federal prison at her scheduled October sentencing.
Crime Fighting Partnership: Global analytics provider Verisk and the National Insurance Crime Bureau (NICB) mentioned above have renewed their 25-year strategic relationship to help combat organized insurance fraud. The relationship enables seamless and integrated access to tools and data that can help protect insurance companies and their policyholders from fraud and other insurance crimes. “By providing data processing, hosting and a powerful, highly secured data fusion environment, Verisk helps the NICB perform analytics that fuel its fight against organized fraud and help the efforts of insurers and law enforcement as they can receive critical alerts from the NICB,” said Maroun Mourad, president of claims solutions at Verisk. “This relationship also strengthens our shared resolve in connecting the anti-fraud community for the greater good.”
LMA Newsletter of 8-22-22
