A former Lackawanna County insurance agent was arrested on Monday, June 11 and charged with stealing more than $50,000 in insurance policy premiums, which he allegedly converted for his own use.

Attorney General Linda Kelly identified the defendant as Ronald Madajeski, 63, 800 Clay Ave., Scranton. Madajeski was a licensed insurance agent and owner of RMI Group located in Dickson City.

http://liarcatchers.com/insurance_fraud.html

According to the criminal complaint between 2010 and 2011, Madajeski allegedly collected more than $50,000 for insurance policy premiums from various businesses for a variety of related insurance policies such as liability insurance, workers compensation insurance and cargo insurance.

Kelly said that once Madajeski collected the money from his business clients he failed to forward the funds to the appropriate insurance underwriters and instead kept the monies for his personal use.

The charges state that Madajeski also allegedly altered documents issued by insurers, despite being unauthorized to make those adjustments. Kelly said that the alterations included increasing the premium cost of policies and directing the insured to make premium payments directly to Madajeski and not the insurer.

Kelly noted that Madajeski allegedly continued to solicit policies, quote insurance premiums and collect additional monies from businesses despite having his insurance agent license suspended by the Pennsylvania Department of Insurance in March 2011.

Madajeski was taken into custody on Tuesday, June 12 and is charged with eight counts of theft by deception, four counts of insurance fraud and one count of forgery.

Attorney General Kelly thanked the Pennsylvania Insurance Department for their assistance with the investigation.

The case will be prosecuted in Lackawanna County by Senior Deputy Attorney General Robert LaBar of the Attorney General’s Insurance Fraud Section.

New York, New York – A Brooklyn board-certified colorectal surgeon, who owned and operated a New York medical clinic, was convicted for his role in a fraud scheme that billed Medicare and numerous private insurance companies for surgeries and other complex medical procedures that were never performed, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.

http://liarcatchers.com/insurance_fraud.html

On Wednesday, June 13, 2012, after a two-week trial in federal court in Brooklyn, a jury found Boris Sachakov, M.D., 43, guilty of one count of health care fraud and five counts of health care false statements.

The trial evidence showed that from January 2008 to January 2010, Sachakov, who owned and operated a clinic called Colon and Rectal Care of New York P.C., defrauded Medicare and private insurance companies by billing for surgeries and medical services that he never provided. According to trial testimony, several private insurance companies began investigating Sachakov after receiving complaints from patients that Sachakov had submitted claims for surgeries, including hemorrhoidectomies, that he never performed.

At trial, 11 of Dr. Sachakov’s patients testified that they had not received the surgeries and other medical services for which Sachakov had billed their insurance companies. The evidence presented at trial showed that the medical records Dr. Sachakov created and maintained on these patients, including letters to the patient’s referring doctors, did not support the extensive billings he submitted. After Dr. Sachakov was confronted by two insurance companies about complaints of billings for surgeries that did not happen, the evidence at trial showed that Dr. Sachakov sent letters to his patients, asking them to falsely certify in writing that they had received the phony surgeries.

The indictment alleged that Sachakov submitted and caused the submission of over $22.6 million in false and fraudulent claims to Medicare and private insurance companies, and received more than $9 million on those claims.

At sentencing, scheduled for Sept. 24, 2012, Sachakov faces a maximum penalty of 35 years in prison and an $18 million fine.

The charges were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; Assistant Director-in-Charge Janice K. Fedarcyk of the FBI’s New York field office; and Special Agent-in-Charge Thomas O’Donnell of the HHS Office of Inspector General (HHS-OIG).

The case is being prosecuted by Trial Attorney Sarah M. Hall and Assistant Chief William Pericak of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS, the New York State Office of Medicaid Inspector General and the New York State Department of Financial Services, Criminal Investigative Division.

The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, strike force operations in nine districts have charged 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.