There are 2 varieties of insurance fraud: soft and onerous. Soft insurance fraud is once the common person tries to pad their claim to get a little bit of additional payment money.
The following 11 insurance fraud scams aren’t your typical insurance fraud scams along they have enough money to take care of several small countries. Forget faux whiplash claims — these cases of insurance fraud make those apear as if kid play. Here are just some of the worst insurance fraud cases of all time and the pricetag of each, most involving the exact people you wouldn’t expect it from, like doctors, lawyers, and even insurance professionals themselves.
11 Insurance Fraud Cases
1.Hospital Corporation of America Healthcare Fraud: $631 million
In many of these cases, it’s the insurance company being defrauded, but in the case of the Hospital Corporation of America, it was you and me. This was a network of hospitals that handled a large number of Medicare cases in the 1990s. Just like the average Joe who needs an extra $200 from his claim, HCA lied a little here, a little there, and what a tangled web they weaved. Before anyone noticed, they’d racked up more than $600 million from fraudulent claims, paid by taxpayers. HCA paid $2 billion in civil lawsuits. Insurance fraud affects everyone that isn’t involved. The actions of just a few can have a far-reaching effect. As a prosecutor so appropriately said at one point in the Unity Outpatient Surgery case, the severity of insurance fraud is comparable to stealing $50 from everyone in Orange County, Calif. — which also happens to be the amount all of the Real Housewives of Orange County have spent on ways allowing them to be “fraudulent” in their own way. Compared to these cases though, there’s not much there’s not one thing fraudulent about them.
2.Rabbi Sholam & National Heritage Insurance Company: $450 million
Big city. Big lights. Big crime. New Yorker Rabbi Sholam Weiss of Brooklyn was responsible for the biggest insurance company collapse due to fraud ever. Weiss sharpened his skills as a con man with his own personal business, but when opportunity knocked, Weiss answered. With several other business owners and lawyers, a team of con artists bought National Heritage and took it for all it was worth. After authorities became suspicious, an investigation was launched, but Weiss fled the country. Fortunately, he was found and is now serving 845 years in prison — the longest sentence ever given for a white-collar crime. Big sentence in the Big Apple.
3.‘Russian Mike’ the Poker-Playing Auto Insurance Fraudster: $275 million
“Russian Mike,” or Mikhail Zemlyansky, was a great poker player, but apparently had a horrible poker face. It certainly wasn’t his game either, and when he decided to try his hand at insurance fraud, the odds were stacked against him. Taking advantage of the no-fault automobile law and employing doctors and lawyers, multiple claims were submitted for unneeded tests and procedures. Personal injury lawsuits also helped the team gain money but NYPD undercover officers were the beginning of the end, with Zemlyansky folding.
4.National Medicare Scam with Fake HIV Clinics: $250 million
Another Medicare scam that swept the country cost millions of dollars and involved doctors, nurses, and medical professionals — you know, those people who take a Hippocratic Oath? A national scam, it affected most major cities, and in Detroit, scammers even developed fake HIV clinics. People came in and paid for care that couldn’t even help them, continuing for months. The scam was eventually shut down and numerous individual cities prosecuted the criminals.
5.Martin Frankel & Liberty National Insurance: $200 million
Martin Frankel was determined to do things a little differently and wanted to be a trendsetter. Instead of committing insurance fraud the old-fashioned way, he thought he’d found a foolproof way to commit fraud — he just outright bought the insurance companies he used to scam policyholders with. He promised policyholders he’d turn their portfolios around to give them better returns, but instead, he just took their money and turned it into money in his own pockets. He placated the others with false reports until state regulators became suspicious. Frankel had been using Liberty National as a front for his cash holdings and was eventually put in prison where he now only sees the lock on his jail cell turned.
6.Unity Outpatient Surgery Center Health Insurance Scam: $154 million
Talk about unity. In the Unity Outpatient Surgery Center scam, a group of people worked together to bill medical insurance companies for $154 million. The participants recruited more than 2,500 healthy people and convinced them to have surgeries they didn’t need, and afterwards the patients would receive cash payments. The thread began to unravel as several surgery centers were charged with fraud, and once investigations started, charges were filed.
7.Health Care One, United Benefits, & Consumer Health Benefits: $100 million
Health insurance is a huge target for insurance scammers as it offers high limits and a multitude of various claims that can be filed. They may say three’s a crowd, but the three companies that took advantage of many families apparently had no problem working together. This trio ended up earning more than $100 million. The three companies, Health Care One, United Benefits, and Consumer Health Benefits, told their customers they were buying major medical insurance when in fact, they only gave them medical discount cards, similar to those you can pick up at the corner of Happy and Healthy (aka Walgreens). When customers finally received medical bills that hadn’t been paid for at all, the scam was revealed, but to this day, nobody has been arrested and although the victims still have to pay, they haven’t started to yet.
8.Houston Mortgage Insurance Fraud Ring: $40 million
In 2007 in Houston, Texas, eight people thought it would be a good idea to commit mortgage insurance fraud. It took a team of real estate agents, loan officers, homeowners, and 300 homes to do so, but the super-sized crime ring managed to pull it off — for a while. The Houston-based FBI mortgage fraud unit finally caught on to their schemes, and they were subsequently charged and put behind bars, where they no longer have to worry about mortgages.
9.Michael Petronella & Devon Kile in Workers Comp Fraud: $38+ million
It’s pretty expensive to live anywhere in California — you pay big time for that sunshine and nice weather. It must have been too expensive though for two men responsible for the biggest workman’s comp insurance fraud case in California. Michael Petronella and Devon Kile were able to enjoy the money for a little while, running three companies which allowed them to file multiple bogus claims. Additionally, they didn’t report an accurate number of employees, and underreported their income for several years. Because of that, they enjoyed quite a few homes and expensive cars, and it also paid for the ultimate getaway — prison.
10.Dr. Jorge Martinez & Health Insurance Fraud: $12 million
Dr. Jorge Martinez was a dirty physician, plain and simple. By submitting false claims for prescription drugs and expensive tests that he never prescribed or performed, Martinez attempted to collect $60 million from insurance companies. Poor Dr. Martinez only managed to get $12 million, but it was still insurance fraud and still significant at that. According to his claims, he was seeing 100 patients per day. Now he’s only seeing bars and cellmates.
11.Tamiami Medical Supply Inc. & Medicare Fraud: $7.4 Million
Federal programs are often taken advantage of by those looking to skim a few dollars off the top and Justo Padron was doing just that. His medical supply business, Tamiami Medical Supply Inc. was abusing the system and once authorities caught on, he had scammed Medicare out of $7.4 million. He was caught by police while burglarizing a vehicle and they chased him into an alligator-filled lake. His body was found the next day. He must have known crocodile tears wouldn’t get him out of that one.