By JAMES QUIGGLE
Coalition Against Insurance Fraud
As microbes march across America, the parallel pathogen of insurance crime also continues prowling for victims. Look no farther than the newest avatars of avarice, the Insurance Fraud Hall of Shame. They’re the No-Class of 2020. These culprits are the year’s 10 worst insurance schemers.
The shamers are dishonored annually by the Coalition Against Insurance Fraud. This year, houses are burned. Military valor is stolen. Fake slip-and-falls take a $31 million tumble. A mother is shot. The Commanders in Thief help put insurance fraud on full national display and with a purpose.
The shamers play a useful deterrent role. Promoting extreme schemes can help harden public opinion against this $80 billion a year crime.
Most people remember vivid stories better than dry data, providing consumers with better recall of insurance criminals such as the shamers. We learn in vibrant detail the damage these Tyrannosaurus Wrecks can inflict on honest Americans. More people then share the shrieks on social media — better-promoting honesty and avoidance.
The shamers also remind America that fraud fighters are committed counterweights to insurance crime — investigating in the field and convicting in court. So enjoy the shamers, up to a point.
Sickening food flimflam. Blame the poisoning on food. Blame it on the restaurant. Actually, blame it on Jacqueline Masse. The Hampton, New Hampshire, woman lied she fell sick from tainted food. She sent 12 letters demanding nearly $400,000 from restaurants and food companies. Insurers paid more than $206,000 to Masse and unknowing family members, who she also claimed were poisoned.
Masse produced fake medical records saying she grew seriously ill after eating their food. Masse also assumed the identity of “sick” family members. Each letter demanded the restaurant or food company reimburse for medical expenses, plus pain and suffering.
Masse forged medical records. She faked bank account and credit card statements to “prove” she dined at the restaurant — or bought food packaged by the food company. Masse received 18 months in federal prison and must repay the stolen insurance money.
Slip-and-tumble con fumbles. Bryan Duncan was a core cog in a sprawling $31.7 million slip-and-fall ring in New York City. The gang recruited hundreds of low-income New Yorkers — many from homeless shelters — to stage phony slip-and-fall injuries around the city. It was one of the biggest slip-and-fall scams in U.S. history.
Ring members bribed his recruits with cash. Many endured unneeded surgeries from colluding medical providers to increase the insurance payouts. The surgeries included discectomies, spinal fusions, epidural injections, and knee and shoulder operations. Duncan recruited patients, organized their legal and medical appointments, and helped procure funding for treatment and lawsuits.
Cronies recruited patients, took them to medical and legal appointments, identified accident sites, paid the recruits, and coached them on how to fake injuries. Inflated lawsuits were filed against property owners and insurers. They sought damages for sidewalk cracks and other claimed defects. Duncan received 80 long months in federal prison.
Mogul’s rehab racket. Christopher Bathum called himself the “Rehab Mogul,” and yet he gave drugs to vulnerable women patients, even as they battled addiction, and sexually assaulted them. Bathum also falsely billed insurers for $175 million of bogus rehab charges while endangering the recovery of trusting patients.
Bathum ran Community Recovery, a chain of rehab facilities in California and Colorado. Thousands of addicted people flocked to Bathum, hoping to get sober from drugs and alcohol. Instead, Bathum gave drugs to women to assault them while they were under the influence.
Bathum also secretly bought multiple health policies for patients. He billed their insurers for rehab he never provided and kept falsely charging insurers after patients left treatment.
Bathum wrote a widely-read psychotherapy treatment book, yet he never attended college and invented his credentials as a psychotherapist. Bathum also had a serious drug problem himself, overdosing in a hotel room. Bathum has 52 years in state prison to sober up.
Arthritis abuse. Dr. Jorge Zamora-Quezada stuck patients with painful, unneeded injections for knees and other body parts in a $325 million insurance rifling. The Mission, Texas, man falsely diagnosed patients with life-long degenerative diseases such as rheumatoid arthritis.
Zamora-Quezada also gave patients knee-buckling doses of chemo and other toxic treatments they didn’t need. Many patients spiraled into despair and depression when he lied and told them they faced a life of increasing pain and limited mobility. Zamora-Quezada kicked patients out of his office if they questioned his treatments.
Insurance money tumbled into his bank accounts. Zamora-Quezada bought a private jet, owned luxury properties in Aspen and other jet-set locales — and owned a fleet of luxury cars. Zamora-Quezada awaits federal sentencing.
Bribery boondoggle. Billionaire insurance magnate Greg E. Lindberg tried to bribe North Carolina’s insurance commissioner with up to $2 million to ease regulatory pressure on his shaky operations. This isn’t a traditional insurance scam. Still, Lindberg earned a place in the Shamer pantheon for his cynical assault on the insurance system.
This also is the story of Commissioner Mike Causey, an honest public servant, who stoutly defended the integrity of his office.
The wealthy Durham political donor ran Global Bankers Insurance Group. He was dissatisfied with lending limits that Causey’s deputy had imposed. Causey also took over several of Lindberg’s companies last year amid concerns they couldn’t meet financial obligations.
Lindberg wanted Causey to remove his deputy and install his own associate. Lindberg’s attempted $2 million bribe sought to channel the money into the commissioner’s re-election campaign.
Causey quickly alerted law enforcement about the bribe attempt. Using an FBI wire, he secretly recorded conversations with Lindberg and several associates. Lindberg was given seven years in federal prison.
Murder for Medicaid. Carl DeBrodie’s body was discovered encased in concrete and hidden in a storage unit. The Kansas City, Missouri-area man was developmentally disabled. Carl’s caregiver, Sherry Paulo, mercilessly tortured and abused him. All the while, she stole nearly $107,000 of Medicaid money for services Carl never received.
Paulo managed a caregiver facility called Second Chance Homes, where Carl lived. She stopped giving Carl his life-giving meal supplements and withheld his antipsychotic and anticonvulsant meds. Carl grew weaker and thinner. Paulo passed off another resident as Carl for a medical appointment. She also forged doctor’s visits for her records.
Paulo finally moved Carl to her home and worried investigators would discover her abuse. Paolo confined Carl in her unfinished basement. The small room had no running water, sunlight or fresh air. Carl was in so much pain that he lay in bed howling. He died. Paulo placed his emaciated body in a trash container, filled it with concrete, and hid him in the storage unit. Paulo received 171/2 years in federal prison.
Rapper’s death riff. Chicago rapper Qaw’mane Wilson wanted fame and riches, so he had his mother shot for the life insurance to finance his career and flaunt his wealth. Wilson’s rapper name was Young QC. He was Yolanda Holmes’s only child. She lavished love on him, trying to keep Wilson out of gang life. Yolanda bought him a Ford Mustang, jewelry and designer clothes. She even helped him find steady work.
Wilson repaid Yolanda with gunshots. He wanted to boost his new rap career with splashy shows of over-the-top wealth. So Wilson hired Eugene Spencer to shoot Yolanda as she slept in her bed. “Make sure the b— is dead,” he told Spencer on the phone before completing Yolanda’s murder.
Wilson later tossed wads of money in the air to squealing fans outside a shopping center. Wilson received 99 years in prison, and Spencer received 100 years.
Skin-deep deceit. A celebrity plastic surgeon blithely billed beauty surgery as essential medical procedures to falsely bill insurers at least $50 million in Rancho Mirage, California.
Dr. David Morrow charged nose procedures as fixing deviated septums. Tummy tucks magically became hernia repairs or abdominal reconstructions. Breast lifts were surgeries for “tuberous breast deformities.”
Morrow forged test results, medical notes and surgical records to back up his fantasy world. He even covered up the text of records for a patient’s tummy tuck. He hand-wrote “umbilical & ventral hernias” on top of the original wording.
Morrow also stole patients’ names, medical info and signatures to secretly charge insurers for surgeries he never bothered performing. Morrow and his wife sold their Beverly Hills mansion for $9.45 million and fled to Israel. Morrow was shipped back to the U.S. to serve his 20-year federal sentence.
NOTE: We know there are only eight fraudsters here. That’s because we deleted the two we printed in earlier editions of the REPORTER.