2019 Insurance Fraud Hall of Shame
The Coalition Against Insurance Fraud releases the newest Insurance Fraud Hall of Shame inductees each year, the worst of the worst in insurance fraud scams, to help bring awareness to the detriment that insurance fraud has on not only all of our pockets at $80 BILLION per year, but to demonstrate that these crimes are not victimless.
We are thankful, because we enjoy sharing them with you!
Here are the 9 newest inductees for 2019 according to Dennis Jay of the Coalition Against Insurance Fraud and Property Casualty 360:
1. “Fire Flimflam”
Claire Risoldi, a wealthy socialite, submitted approximately $20 million worth of inflated claims to her insurer for possessions that were allegedly destroyed when her Bucks County, PA mansion mysteriously went up in flames. Among the inflated claims were $10 million worth of jewelry (in which she also alleged were stolen by firefighters), $950,000 in hand-painted walls and ceiling murals, along with hundreds of thousands of dollars she allegedly spent on draperies infused with crystals.
Upon receipt of insurance proceeds, Risoldi continued to spend, spend, spend. She purchased, “more homes, six Ferraris, two Rolls Royces, a Cobra and other vehicles for her and her family members.”
Risoldi was sentenced to two years in prison.
2. “Slip-and-fall stumbles”
Peter Kalkanis orchestrated a $32 million slip-and-fall ring by preying not only on insurance companies, but on “street people and other down-and-outers” by recruiting them to stage tripping and falling on the sidewalks of New York in exchange for cash.
Hundreds of destitute recruits were coached on how to fake back, knee, and shoulder injuries. What is even more disturbing is that Kalkanis forced some recruits “to have life-altering – and unneeded – spinal fusions and other surgeries to inflate their claims even more.”
Furthermore, Kalkanis had an army of crooked doctors to perform bogus medical exams and conspiring attorneys to push insurers for large settlements.
Kalkanis is currently awaiting sentencing.
3. “Singed scam”
Diomedes Ceballos hired his younger brother, Aurelio Ceballos DeLeon, to set fire to his home in Scranton, PA to collect a $500,000 insurance payout. However, according to Dennis Jay of the Coalition Against Insurance Fraud, “Aurelio knew nothing about fire. He lit gasoline with a lighter and was promptly engulfed by fire. Aurelio lurched outside on fire; his clothes nearly all singed off. Somehow, Aurelio staggered to his apartment. A friend found him there, dying. Still, Aurelio wouldn’t call 911. His addled brain worried more about the police discovering the arson than about saving his own life. Aurelio died the next day.”
Diomedes Ceballos originally purchased his home for $86,000, but insured it for $500,000 in hopes to eventually collect the payout. Instead, he’ll be spending up to 20 years in jail.
4. “Uncaring nursing care”
Phil Esformes of South Florida was at the head of one of the largest insurance fraud schemes in United States history, totaling $1.2 billion.
According to Dennis Jay, “Esformes stuffed 14,000 addicts, mentally ill and street people into assisted-living facilities and nursing homes. He overbilled their Medicaid and Medicare accounts for services people didn’t want, need or receive.”
Among Esformes’ purchases with the insurance fraud proceeds were a $1.6 million Ferrari and a private waterfront mansion. However, it’s all gone, as he’ll be spending the next 20 years in prison.
5. “Disability fright night”
Thomas Lucey, a Boston, MA trolley car driver, was allegedly assaulted and mugged on the job by a man wearing a Michael Myers mask just before Halloween. As a result of the “attack,” Lucey claimed post-traumatic stress disorder and began collecting long-term disability payments.
However, investigators determined that Thomas Lucey planned the alleged attack. According to Dennis Jay, “the guy climbed onto Lucey’s trolley at a pre-arranged spot after midnight just before Halloween. The mugger also wore dark overalls and carried a plastic pumpkin. He yanked Lucey from the trolley, shoved him to the ground, fake-mugged him and ran away. It was staged theater for the trolley security cameras.”
The break in the case came when fingerprints were pulled off the plastic pumpkin that the masked man dropped during his escape. Lucey is currently awaiting sentencing.
6. “Slip scam iced”
Alexander Goldinsky filed an ambulance and hospital claim with insurers for injuries sustained during a slip-and-fall while working as a subcontractor at a New Jersey firm. Goldinsky also made national news when security footage of this alleged slip-and-fall was released.
According to Dennis Jay, “Security cameras captured him wandering into the company’s cafeteria. He goes to the ice machine, fills a cup with ice, then spills the contents onto the floor. Goldinsky then lies down amid the ice. He waits for someone to show up and discover him in seeming distress.”
Goldinsky is awaiting sentencing.
7. “Phony phone exams”
Lester Stockett collected approximately $2.1 million of a $424 million international Medicare scam that capitalized on a growing trend; telemedicine, or phone/video exams performed by doctors.
Dennis Jay indicated that the scheme included, “boiler rooms of telemarketers operated in Latin America and the Philippines. Callers recruited hundreds of thousands of seniors, setting them up for bogus medical phone exams. Stockett bribed doctors to give seniors brief phone exams of no medical value. The providers piled on prescriptions for expensive braces the seniors didn’t need or want.”
Stockett is awaiting federal sentencing.
8. “Alligator assassin”
After investigators were unable to find Mike Williams’ body, it was determined that he had drowned and was eaten by alligators while fishing out on a boat with his best friend on a lake near Tallahassee, FL in December 2000.
However, the case was reopened when investigators learned that alligators don’t eat in winter.
Turns out, Mike Williams’ wife, Denise, was having an affair with his best friend, Brian Winchester, and planned on collecting his $1.75 million life insurance policy. Dennis Jay stated, “Winchester pushed Mike from the boat into Lake Seminole in December 2000. He shot Mike as he flailed in the chilly water. Winchester buried him in a remote area, lying that Mike had drowned.”
Denise Williams has been sentenced to life in state prison, and according to Dennis Jay, Winchester “took a plea deal in exchange for immunity, although he was given 20 years for kidnapping Denise after they married.”
9. “Failed sobriety test”
Jason Gerner was the co-founder of Liberation Way, a corrupt rehab network that “forced desperate addicts to relapse in a $100 million plot to milk insurers in Pennsylvania,” according to Dennis Jay.
Jay further stated, “Gerner shuttled addicts to crooked rehab centers every day. One center was called a ‘party house’ – addicts could easily score drugs there. Employees also had sex with addicts.”
The goal was to encourage addicts to continue relapsing, some six or more times, in order for Garner to bill insurers for overpricing drugs tests and rehab stays.
Gerner is awaiting federal sentencing.