Slip, Fall and then some…

Alexander Goldinsky staged a ham-fisted slip-and-fall on ice in a company cafeteria, then tried to wriggle out by seeking pre-trial intervention that could’ve led to the insurance fraud charges being dropped. No go, the New Jersey court ruled. Goldinsky was sentenced to two years of probation plus community service for insurance fraud. The Randolph man was an independent contractor at the victim business. Goldinsky claimed he was seriously injured after slipping on ice lying on the cafeteria floor. He was taken to the hospital, claiming painful injuries. Goldinsky also lied that he developed stuttering speech, suffered from constant headaches, started dropping items, and experienced painful “frozen spasm sensations” plus heavy eyelids. Goldinsky incurred more than $23K in medical bills. Except he staged the fall right in front of snooping cafeteria security cameras. Footage shows Goldinsky dropping ice from a cup onto the floor, lying down, then acting hurt. Goldinsky’s scam was an overnight media sensation. The security footage was replayed on TV news programs around the U.S. Goldinsky pled guilty to insurance fraud, then sought pre-trial intervention. He showed an “inability to acknowledge his wrongdoing and make amends” — making him a poor candidate for the program, the prosecutor said. Nor did he prove the rejection of his application was a “patent and gross abuse of discretion,” the appellate court ruled this week. Case closed, though Goldinsky’s ultimate sentence was election to the Coalition’s Insurance Fraud Hall of Shame in 2019.

With $2M of life insurance dangling before his eyes, Nicolas Shaughnessy hired two hitmen to shoot his parents in their Austin, Tex. home. Ted was a well-known local jeweler. He and his wife Corey were in their bedroom when they heard someone enter their house in the middle of the night. They grabbed handguns. Ted was shot dead in a hallway when he confronted the intruders. Corey returned fire with a .357 revolver until she ran out of ammo, and crawled into a closet to call 911. She survived the assault. Detectives found no signs of forced entry. Nicolas also had remote access to his parents’ home security system. He used his cellphone to shut off the security system. He also accessed his parent’s home security account and deleted surveillance video taken during the shooting. Nor did Nicolas show any emotion after his father’s death, or concern for his mother. He even joked about the crime with friends. Five .380 caliber bullet casings found at the scene also matched a box of rounds found at Nicolas’ apartment; six bullets were missing from the box. Nicolas was given 35 years in state prison, as were hitmen Arieon Oneal Smith and Johnny Roman Leon III pled guilty and received 35 years. Nicolas’ now-ex-wife Jaclyn is charged.

A drug sales rep teamed with a pharmacy and doc to bill health plans for $2.2M of unneeded compound meds in Tuscaloosa, Ala. Sales rep Brett Taft provided Dr. Paul Roberts with pre-written prescription forms for the compound drug recipes. Roberts issued the scripts, sometimes without patients’ knowledge. Stanley Reeves of F&F Drugs filled the scripts and billed the cost to health plans. Reeves paid Taft a portion of the insurance money, and Taft used some of the money to pay off Roberts. F&F Drugs also illegally waived patient copays to induce their business. To maximize profits, F&F Drugs automatically refilled the compound drugs that Roberts referred — whether or not patients needed the meds. Taft received a year in federal prison. Roberts earlier was sentenced to 72 months. Reeves earlier received 38 months; the scheme was part of a larger $10.5M billing con involving several pharmacies.

Kids with disabilities made Diandra Bankhead a wealthy scammer. The former Atlanta woman falsified paperwork and her medical credentials to start up a bogus Medicaid program that purported to treat kids with physical and cognitive disabilities. Bankhead lied that a registered nurse oversaw Elite Homecare’s services, and that an RN supervisor evaluated the kids. Bankhead made more than 5.4K claims, most of which were bogus. She billed for phantom services, and for kids that Elite never saw. Bankhead billed for more than 24 hours of treatments in a day, and for treating multiple kids at the same time. She even billed for an infant who died. And Bankhead illegally farmed out kids who were former clients to another med firm for a percent of that firm’s Medicaid billings. She received five years in state prison and must repay nearly $1M.

A San Diego-area chiro billed the military’s health program and Medicare more than $7.2M for physical therapy while actually doing so-called “integrated” treatment that wasn’t covered. Joserodel Zavala Candelario ran RISE Wellness Center. He did chiro, massage, acupuncture and diagnostic services. Most treatments weren’t covered, so Candelario simply billed using codes for physical therapy, which is covered. Patients who thought they received decent treatment instead got substandard care. Candelario pushed his staff to run diagnostic tests on every patient, regardless of medical need. He also demanded that staff meet quotas for diagnostic tests, and for durable medical equipment, massages and other services — also regardless of need. And Candelario imposed quotas for patients with specific types of insurance coverage (e.g., 60 Tricare patients per day) even if they didn’t need the treatments. He pushed his schedulers to cram in as many as 50 patients per day for each staff provider. Chiros were allowed to treat patients only if they first prescribed X-rays and three other diagnostic tests, plus back braces and other equipment. Candelario fired or marginalized staff who complained about the scamming. He received three years in federal prison.

Geico has filed a $300K federal lawsuit in Arizona against A&G Auto Glass for allegedly phantom and over-billed windshield replacements. Geico lays out this case: Comprehensive auto coverage is optional for drivers in Arizona. But insurers that offer the coverage must allow drivers to cover windshields without a deductible. The drivers can make an Assignment of Benefits to their auto glass shop, allowing the shop to bill the insurer for windshield work. Insurers in Arizona are vulnerable to auto glass scams because of the high volume of claims under the no-deductible/AOB setup — coupled with a short time frame (usually 30 days) for insurers to pay claims. Geico alleges A&G billed for phantom windshield replacements, or installed lower-quality and less-expensive windshields. A&G often generated two invoices. One was for the insured driver, showing the actual windshield installed. The other was for Geico, showing the more-expensive windshield. Geico filed a similar lawsuit in Arizona last year against Auto Glass Express.

A prison teacher slashed herself to obtain workers comp benefits. Marybeth King was a special-ed teacher at the maximum security Great Meadow Correctional Facility in Fort Edward, N.Y. She was teaching a class when an inmate raised his hand, King said. She went to his desk, then said she felt something on her leg. She looked down and said her pants and leg were sliced. King contacted prison security after noticing a razor blade on the desk. She wasn’t seriously injured, and had the 2 ½-inch cut stitched at a hospital. King later admitted to investigators that she faked the attack to obtain comp benefits. She received five years of probation.

An agent set up two sham employers to fool Blue Cross Blue Shield into thinking he sold health coverage to hundreds of nonexistent employees in Pennsylvania. Jonas Knopf ran Madison Financial Services. The Lakewood, N.J. man used false personal info, including addresses, DOB, marital status and job functions to profile the phony workers. He also set up the fake employers to create the illusion of valid employees in Pennsylvania. BCBS ultimately paid $1.5M of fraudulent claims. Knopf was initially accused of a much-larger scheme in 2018. Those charges involved 11 sham employers and $10M of fraudulent claims. But Knopf admitted only to the $1.5M scheme. He faces up to five years in federal prison when sentenced Aug. 19.

Ivan Andre Scott ran a firm that cold-called seniors and signed them up for fake DNA cancer screening tests to loot Medicare. The Kissimmee, Fla. man persuaded the seniors they were eligible for the tests, which cost about $6K each. He bribed telemed companies to have docs write scripts for the tests — yet the docs never saw the patients or treated them for cancer. Scott then sold the scripts to testing labs for illegal kickbacks. He invoiced the labs for hourly “marketing” services instead of for medical referrals, to hide the scheme. The labs made over $3.3M of test claims to Medicare. Scott received $194K in kickbacks for his role, and was handed 10 years in federal prison. He was scooped up by Operation Double Helix. It’s a national federal probe that has led to charges against dozens of suspects involved with telemed firms and DNA cancer-testing labs around the U.S.