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Inside This Issue

The War on Drugs, and Ultimate Drugs: Wealth, Power and Political Influence

 

By:  George Michael Newman, CFE, CCDI, CII

 

(An earlier reviewer of this article thought it seemed to be an editorial espousing legalization or decriminalization of drugs. In fact, this is not its intent, as attention to the detail of the words chosen in various portions of the piece should reveal. Greater mind’s than that of the author must create any realized solution. However, certain undeniable realities weave themselves amongst the panorama/constellation of ‘the drug world’ in blunt format, and denial or ignorance on the part of an investigator invites assessment errors. In abstract form, in context with any set of circumstances, what is revealed here is applicable in any country or segment of society.)

“Gangs have been a major contributor to the growth of violent crime in the past decade. Heavily armed with sophisticated weapons, gangs are involved in drug trafficking, murder, witness intimidation, robbery, extortion, and turf battles. Gangs now operate in cities of all sizes, as well as suburban communities throughout the United States; gang violence is no longer limited to major cities.”(1)

 

Most law enforcement entities relate that the significant spread of methamphetamines as a popular street drug initiated in the mid-1960s, and was a primary source of subsistence income for then-burgeoning ‘outlaw’ motorcycle clubs. Most will also relate that, in time, certain of these fraternities became ever more sophisticated, to the point where they became legitimately incorporated entities; some of which spread across the nation. A few have taken root in several foreign countries, resulting in an ever-increasing profitability; a growth at least initially enabled by drug profits.


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Editor's Note: JCFR has been covering insurance fraud stories since 1994. The one story that has most gripped our reading audience is the Kaitlyn Arquette story. No matter where I go or who I run into, someone will invariably ask me if Lois Duncan ever got the answer to her question, "Who Killed My Daughter?"

I first met Lois Duncan at the 1995 Texas International Association of Special Investigation Units annual seminar. (She'd been asked to fill in at the last minute for the scheduled dinner speaker, Texas Governor George W. Bush.)

No matter what Bush was intending to say, he could not have come close to Lois Duncan.   MORE

   

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We at John Cooke Fraud Report are dedicated not only to providing educational information and training to industry fraudfighters, but to Joe & Jane America as well.  Therefore,  www.fightfraudamerica.com was created as a forum for public education. 

We welcome your comments and suggestions for both sites. 

 

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Recent articles SUB

9 Doctors Charged with Medicare Fraud SUB

Antifreeze - The New Murder Weapon of Choice SUB

Apple Trees and Bad Guys SUB

Burn, Burn, Burn SUB

Burying the Dead...Cultural Beliefs SUB

Dos Vidanya Sasha

Editor's Rant

Fight Fraud America...It's Already Working!

Finally!!!!  You Wanna Play Big, You Gotta Pay Big SUB

Fraud & Workers' Compensation

Gap Insurance Fraud SUB

Gift Card Fraud SUB

Introducing DATAMEX!

Just How Wide IS Workers' Comp Premium Fraud? SUB

Muslim 101

NCOIL to Deflate Airbag Scams, Pursue Model Law

Never Insure Intentional Acts SUB

ND Agent Suicide Prompts Investigation SUB

New York Family Affair SUB

Searching the Past to Better Understand the Present SUB

Six Million in Fake Policies SUB

The Future of P&C SIU

The War on Drugs, and Ultimate Drugs: Wealth, Power and Political Influence

There Is No Such Thing As a Bad SIU

To Change or Not to Change, That is the Question SUB

Video Surveillance Fraud SUB

What Insurers can do About Escalating Medical Fraud in Health & Property/Casualty Insurance

What's in a Name? SUB

"Who Killed My Daughter" The Story of Kaitlyn Arquette

 

Sudoku Puzzle

 

 

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NCOIL TO DEFLATE AIRBAG

SCAMS, PURSUE MODEL LAW

   

A fraud by any other

name is still a fraud

   

The John Cooke Fraud Report is restricted to the fraud detection industries.  Investigators share their tips and knowledge with us to help their peers, not their antagonists; accordingly this publication will never be offered to the general public.  To subscribe to the John Cooke Fraud report, please click HERE.

   

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L. Burke Files

Due Diligence — Giving Away Data

 

 

 

 

 

 

 

 

 

Washington, DC, March 3, 2009 — Lawmakers at the National Conference of Insurance Legislators (NCOIL) Spring Meeting here vowed to pursue model legislation that would take wind out of airbag fraud—scams in which, through theft and insurance misdealing, auto repair shops and other entities jeopardize consumer safety to chase monetary reward.  The March 1 Property-Casualty Insurance Committee decision commits the group to considering a model based on current state approaches. 

Of interest to legislators is requiring body shops to show an airbag bill of sale before insurer reimbursement;  MORE

© 2008

Barry Zalma, Esq., CFE

The United States Ninth Circuit Court of Appeal has recognized that the Americans With Disabilities Act ("ADA"), a law with great intentions, that fell afoul of the law of unintended consequences.  The abuse of that law has created an industry of litigation that is more like extortion than an attempt to redress wrongs.


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What Insurers Can Do about Escalating Medical Fraud in Health and Property/Casualty Insurance

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By Dr. Barry L. Johnson

Fraudulent medical schemes are a growing problem in the health and property/casualty insurance sectors. In fact, they are the largest issue facing the industry today. Unfortunately, the volume and expansion rate of medical fraud is uncontrolled in comparison with other property/casualty risks. The Insurance Research Council (IRC) estimates that fraud and abuse losses in the health care industry waste an estimated $70 to $255 billion annually and contribute to rising expenditures. In addition, 18 to 27 percent of bodily injury claims and 12 to 17 percent of personal injury protection claims contain the appearance of buildup or fraud. Perpetrators of such fraud range from insureds, members and providers, all the way to organized fraud rings.

 

Billions of dollars are wasted each year on payments made as a result of falsified medical claims.  Not  only  does

Burn, Burn, Burn

In yet another creative business venture, a 61 year old former Binghampton, NY, realtor is on his way to prison to serve a ten year sentence.   SUBSCRIBERS ONLY  SUBSCRIBE NOW

 

Stupid Claimant Tricks

Fight Fraud America...

It's Already Working!

This issue's prize goes to Jerome Dobies, a Brecksville Ohio resident...MORE

If you haven't yet looked over the FightFraudAmerica.com web site, do yourself a favor and get familiar with it. We've already had some success stories, but the latest one bears telling right now.  MORE

this affect the property/casualty and health care insurance industries, but it also exploits state and government health care programs.  For example, Federal authorities recently arrested more than thirty suspects, including doctors and health care business owners and operators across the nation, suspected in a major Medicare fraud scheme. Their scams included giving patients “arthritis kits,” which were nothing more than expensive orthotics, such as knee or shoulder braces and heating pads, billed at $3,000 - $4,000 each. Another recent Medicare fraud case involved a doctor in Miami, FL, and two physician’s assistants billing the government program for $10,903,509 worth of unnecessary HIV infusion treatments. All three conspirators have been sentenced to prison terms.  

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Muslim 101

Part of the Cultural Diversity Series for Investigators

Imagine that there are five people sitting around a table in Anytown USA.    MORE

 

Burying the Dead...

Cultural Beliefs

More often than not, bodies are buried in US cemeteries with the head on the west end of the grave.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

Global Gotchas

1995 Archives

1996 Archives

1997 Archives

1998 Archives

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Antifreeze - The New Murder Weapon of Choice

It took jurors only three hours to convict Marguerite Bork of Second degree murder. She's facing 25 years to life in prison when she get sentenced in May, 2007. SUBSCRIBERS ONLY  SUBSCRIBE NOW

Just How Wide IS Workers' Compensation Premium Fraud?

Six Million in Fake Policies =

Ten Year Prison Sentence

A study in New York done by the Fiscal Policy Institute reported that an estimted 15% of payroll had not been reported to insurers. How many billions did that cost insurers ... and the honest businesses that footed the bill when the costs were passed on?  SUBSCRIBERS ONLY  SUBSCRIBE NOW

An Australian financial company rated insurance claim records against zodiac signs, This may be a case of someone with way too much time on his/her hands, but for what it's worth, here are the results:
 
 Drivers, Worst to Best:
 #1 Gemini
 #2 Taurus
 #3 Pisces
 #4 Virgo
 #5 Cancer
 #6 Aquarius
 #7 Aries
 #8 Libra
 #9 Leo
 #10 Sagittarius
 #11 Scorpio
 #12 Capricorn

What's an easy way to acquire interest in two buildings in San Francisco, a condominium in Las Vegas and a condominium in the Cayman Islands?  SUBSCRIBERS ONLY  SUBSCRIBE NOW

ND Agent Suicide Prompts Investigation
Finally!!!! You Wanna Play Big, You Gotta Pay Big

Mystery surrounds the largest fraud case to hit North Dakota in the past 20 years. The only person who could have provided the answers -- all of the answers -- was Diane Cottingham, owner of agencies in Bismark, Washburn and Underwood. And she''s dead.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

Three cheers for the Seventh District Circuit Court, for doing (04/04) an excellent job of imposing justice. Krishnaswami Sriram admitted in Federal District Court that he had heavily defrauded the Medicare program -- and the IRS for another $550,000.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

9 Doctors Charged with Medicare Fraud

The New Kid in Town...

Gift Card Fraud

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Gift Card Fraud is the new kid in town. Plenty of towns, in fact.  One of the more recent cases was just popped by the Gainesville Police Department (GPD, and resulted in the arrests of  SUBSCRIBERS ONLY  SUBSCRIBE NOW

Imagine this scenario. Doctors, "cappers" and board-and-care administrators cooperate to make elderly, infirm and mentally ill patients available to get unnecessary respiratory therapy treatments. Why?  SUBSCRIBERS ONLY  SUBSCRIBE NOW

New York Family Affair

The Future of P&C SIU

The courtroom looks like the stage for a Houghtaling family reunion. On trial are brothers Frank and Joseph Houghtaling, their twin sister wives Renee and Rhonda Houghtaling, the mother Donna Houghtaling, and her daughter, Brenda Warner.. The family is accused of staging 23 crashes to collect insurance money.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

The year is 2017. The teleportation machine is still glowing as we walk into the building that houses "The Futuristic Insurance Company."  Looking around we notice that data-mining technology has made rapid advancement in the past ten years. Looking at adjuster Tamara Tomorrow's desk we see that when a claim is presented to a company, it is instantly linked cross industry. The issued report not only points out probable connections, but inter-company links are utilized, records are automatically merged and files are tagged for immediate report to overseeing agencies. Gone are the times of multiple claims for a single incident. Tamara is relaxed and smiling. MORE

 

Video Surveillance Fraud?

The insurance industry is required to follow stringent rules when filming claimants. There are restrictions on where you can film, what sort of lenses you can use, what vantage point you choose ... and all sorts of rules having to do with expectations of privacy.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

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Gap Insurance Fraud

Along with fluctuations in the overall economy, comes the spawning of new forms of insurance fraud. Take, for instance, Gap Insurance Fraud, a new scam perpetrated on companies that emerged to fill a "gap" in the (primarily) auto insurance marketplace.  SUBSCRIBERS ONLY  SUBSCRIBE NOW

   

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