Fraud Roundup

A Miami-Dade County man was arrested for practicing dentistry without a license and submitting fraudulent Medicaid claims, according to Florida’s Attorney General Charlie Crist.

Orlando Sotolongo Guarton allegedly posed under the name of an actual licensed dentist, Dr. Lorenzo Puentes, for a year.

The Medicaid Fraud Control Unit revealed Sotolongo had been treating patients, providing invasive dental services and issuing prescriptions for antibiotics and painkillers. Among the dental services Sotolongo allegedly performed were extractions, sometimes done without anesthesia.

Sotolongo is charged with five counts of practicing dentistry without a license and one count of Medicaid fraud, both third-degree felonies. If convicted on all charges, he faces up to 30 years in prison and $30,000 in fines. The case will be prosecuted by the Miami-Dade County State Attorney’s Office.

Kentucky psychiatrist sentenced
Kentucky Attorney General Greg Stumbo announced that Dr. Arthur Daus, a psychiatrist practicing in the Louisville area, has been sentenced in Jefferson Circuit Court for illegally over-billing Medicaid and Medicare for multiple office visits even though patients made only single visits.

Daus received a sentence of one year, probated for a period of two years on the felony count of devising or engaging in a scheme to defraud the Kentucky Medicaid program, and 12 months probated for two years on the misdemeanor count of theft by deception for improperly obtaining funds from the federal Medicare program.

Kile Insurance Agency head indicted in W.Va.
Long-time insurance agent Bennie H. Kile Jr. of the Kile Insurance Agency in Sistersville, W.Va., has been indicted on seven insurance fraud felony counts, according to Insurance Commissioner Jane L. Cline. Each count carries a one to 10 year prison sentence and fines of up to $2,500.

Kile allegedly took money from customers for promised insurance policies and then failed to provide those policies on at least five instances. He also allegedly forged a customer’s signature on an insurance application form.

Kile was indicted by a Tyler County Grand Jury on five felony counts of conducting a fraudulent scheme, one felony count of forgery and one felony count of uttering.

Fla. DFS Revokes Family Insurance’s license
The Florida Department of Financial Services has revoked the license of Bruce Anthony Fonte, owner of Family Insurance of West Pasco, Fla. Fonte operated Family Insurance of West Pasco located at 6640 Ridge Road and admitted leaving possibly dozens of home and business owners without insurance during the 2005 hurricane season. Fonte failed to forward premiums to insurance companies to bind coverage for his clients, and instead used the premiums for personal expenses.

In January, Fonte was placed under an emergency suspension as allegations began to emerge. He is now permanently banned from engaging in the business of insurance in Florida.

Fla. scheme misappropriated $845,000
John Paul Castagna, the owner of Castagna Specialty Risk, in Deerfield Beach, Fla., was apprehended by the Department of Financial Services Division of Insurance Fraud for allegedly stealing more than $845,000 in insurance premiums he received from 17 victims who intended to buy boat insurance. Castagna could face up to 180 years in prison.

Castagna Specialty Risk was formerly at 201 N. Federal Highway, Suite 111 and 265 S. Federal Highway, Suite 342. He was booked on charges of misappropriation of insurance premiums, two counts of grand theft in the first degree, four counts of grand theft in the second degree, and six counts of grand theft in the third degree. Bond was set at $48,500.

An investigation determined that, from November 2001 through April 2004, Castagna engaged in an ongoing scheme wherein he accepted insurance premiums for marine insurance from insurance agents and did not forward the premiums to the insurance companies. In each instance, detectives said, Castagna received the insurance premiums from the agents and deposited the funds into his bank account. Officials said that the charges against Castagna are based on reports from local victims, including customers, insurance companies, insurance agents and finance companies.

W.Va. defendant indicted
West Virginia Insurance Commissioner Jane L. Cline announced that Paul V. Dixon was indicted on one felony count of wrongfully seeking workers’ compensation benefits.

Dixon was allegedly injured at home while trimming a tree on his property; however, he claimed a work related injury against his employer, Grimes Trucking.

Dixon, of Corinth, W. Va. in Preston County, was indicted by a Preston County Grand Jury on the felony charge after filing a claim that resulted in more than $59,000 in benefits paid.

If convicted of the charge, Dixon faces one to 10 years in prison and a fine of up to $2,500.

N.C. suspect apprehended
Perry Murray Wilson, 53, of Black Mountain, N.C. was apprehended on six felony charges including two misdemeanor charges of selling insurance without a license, financial identity fraud, obtaining property under false pretenses and forgery.

According to the Department of Insurance, Wilson was involved in an elaborate scheme to defraud his business partners by gaining their trust and utilizing their credit-worthiness to establish lines of credit worth more than $125,000. Wilson then allegedly transferred the money into his own business accounts.

Last December’s shooting at the Tedesco Insurance Agency in Asheville sparked the Insurance Department involvement in the case. “After the shooting, the department went in to make sure that the company was stable and the clients taken care of; however, when our investigators started talking with Wilson’s partners, details and allegations came out about his scheme to defraud them,” Insurance Commissioner Jim Long explained. As the investigation continues, further charges may be brought.

Broward woman arrested for fraud
A Broward County, Fla. woman, who attempted to collect twice on her hurricane claim has been arrested and charged with a third-degree felony for making false claims. Indrani B. Horton, 34, of Margate, was charged with filing a fraudulent claim.

Horton is charged with collecting $7,000 in additional living expense money and then using the same receipts from that claim to bill $6,000 to a second insurance company for an additional living expense claim on another property. Additional living expenses are paid to policyholders who have to move out of their damaged homes to pay for food, lodging and essential items.

If convicted, Horton could face a sentence of five years in prison and a fine of up to $5,000.

Sloan sentenced for W.Va. fraud
Charles Albert Sloan has been sentenced on one count of wrongfully seeking workers’ compensation benefits and one count of fraudulently obtaining a controlled substance, both felonies, according to West Virginia Insurance Commissioner Jane L. Cline.

Sloan, of Elkins, W. Va., pleaded guilty to the charges and was sentenced to one to four years confinement; however, the sentence was suspended and Sloan was placed on five years probation.

In addition to being placed on probation, Sloan was ordered to pay restitution in the amount of $1,527 to local physician offices and pharmacies as well as complete 100 hours of community service.

Fla. scam victims receive $2.9M
Two Florida businessmen have been ordered to pay more than $2.9 million in restitution to consumers as part of their criminal sentences for their roles in an insurance scam, according to Florida Attorney General Charlie Crist.

William Paul Crouse and Carmelo Zanfei, the principals of TRG Marketing, LLC, were sentenced for selling unauthorized health plans to more than 7,000 Floridians, resulting in millions of dollars of unpaid claims.

The two sold an unauthorized self-insured health plan in Florida and 43 states, claiming it was exempt from Florida licensing and certification requirements. Investigators determined that the health plan was insufficiently funded and the company failed to pay millions of dollars in claims.

Crouse pled guilty to racketeering and four counts of unlawful transaction of insurance in June 2005 and was sentenced to four years in prison. Zanfei pled guilty to conspiracy to commit racketeering and four counts of unlawful transaction of insurance in June 2005, and was sentenced to two years in prison.

Both defendants also received 20 years of supervised probation on condition that they make restitution to victims after they are released from prison.