Copy
View this email in your browser
November 2020
Arrests  |  Convictions  | Submit a Referral

Investigation of Fraudulent Prescriptions Leads to Arrest


 On November 3, 2020, Jennifer Fezza was arrested in Butler County, following a joint investigation conducted by the Office of Attorney General’s Insurance Fraud Section and Bureau of Narcotics Investigations.According to the criminal complaint, a Butler Memorial Hospital representative reported to the Office of Attorney General that Fezza had allegedly used a hospital physician’s DEA number and other identifying information to obtain a prescription for the schedule II controlled substance Methylphenidate. Investigators spoke with the physician who confirmed that she did not authorize or sign the prescription in question.The physician allegedly told investigators that Fezza was a current patient, but had been issued only three prescriptions during an office visit on February 22, 2019.  According to the complaint, the doctor advised that any such prescriptions purportedly issued after April 21, 2019, were fraudulent. Investigators allegedly determined that a total of 13 such prescriptions for Methylphenidate pills were illegally filled by Fezza after that date. According to the complaint, Fezza used her UPMC and You prescription insurance plan to pay for the pills. Fezza was charged with one count of Acquisition of a Controlled Substance by Fraud (F), one count of Criminal Attempt/ Acquisition of a Controlled Substance by Fraud (F), one count of Insurance Fraud (F3), one count of Identity Theft (M1), one count of Forgery (M1), and one count of Theft by Deception (M1).
 

On November 23, 2020, Sameerah Graham was arrested in Lycoming County.  According to the criminal complaint, Graham filed a fraudulent claim with Progressive Insurance on May 20, 2020, for damage to her Honda which resulted from a deer strike. Graham allegedly obtained the Progressive policy on May 11, several months after her previous vehicle coverage was cancelled. The complaint stated that on May 14, Graham called Progressive and added rental coverage to her new policy, effective May 19. During the call, Graham allegedly asked the representative if the rental coverage would apply in the event that her Honda struck a deer. The complaint stated that shortly after 7:00 AM on May 20, Graham called Progressive and reported that the front passenger side of her vehicle was damaged from a deer strike as Graham was driving home from an overnight work shift. During the claim investigation, the insurer asked Graham to provide additional information, including copies of her recent work timesheets. According to the complaint, Graham provided timesheets which indicated that she had worked 40 hour weeks as a home health care aide on weeknights from 11 PM to 7 AM. Investigators contacted Graham’s employer to confirm the information. According to the complaint, Graham’s supervisor maintained that Graham had not worked on the May 20 date of loss and only worked every other weekend. The supervisor also allegedly maintained that the timesheets provided to Progressive were not utilized by the home health company. Progressive denied payment of Graham’s claim.   Graham was charged with one count of Insurance Fraud (F3), one count of Insurance Fraud (M1), and one count of Criminal Attempt/Theft by Deception (F3).

On November 18, 2020, Lindsay Overs was arrested in Montgomery County.  According to the criminal complaint, on March 13, 2020, the Progressive Insurance policy covering Lindsay Overs’ vehicle was cancelled for non-payment. On March 27, 2020, at 5:53 PM, Overs allegedly was operating her uninsured vehicle when it struck the rear of a SEPTA bus, damaging both vehicles.  The complaint stated that at 6:07 PM on March 27, 2020, Overs used Progressive’s mobile app to reinstate her policy. In doing so, Overs allegedly filed a statement of no loss, indicating that her vehicle had not been involved in any accidents during her lapse in coverage. According to the complaint, at 8:46 AM on March 30, Overs used the mobile app to report that her vehicle struck a SEPTA bus at 6:45 PM on March 27.  A subsequent investigation allegedly revealed that the accident occurred before Overs’ policy was reinstated. Progressive denied payment for the damage to Overs’ vehicle. Overs was charged with one count of Insurance Fraud (F3), one count of Insurance Fraud (M1), one count of Theft by Deception (M1), and one count of Criminal use of Communication Facility (F3).
On November 16, 2020, Chad Carless was arrested in Berks County.  According to the criminal complaint on March 28, 2018, Carless obtained a vehicle policy from State Farm Insurance and provided a Reading, Pennsylvania address. On October 10, 2018, Clifton, New Jersey police responded to a “suspicious vehicle” report. According to the complaint, the police located the vehicle and determined that it was registered to Carless. The officer reportedly noted that the vehicle’s entire front end, side mirrors and taillights were missing and that its interior was stripped.   Carless allegedly contacted the Spring Township Police Department on October 11, 2018 and reported his vehicle stolen.  According to the complaint, he filed a vehicle theft claim with State Farm on the following day. Carless allegedly told the insurer that he had parked the vehicle at his Reading address on September 27 or 28 then went on vacation until October 1. Carless allegedly claimed that he returned to his other residence in the Bronx, New York, and did not go back to Reading until October 11, 2018, when he reported the vehicle stolen. According to the complaint, on May 22, 2019, Carless testified at an Examination Under Oath that he works seven days a week at a car wash business that he owns in New York. Carless allegedly claimed to the insurer that he paid $3,900 to replace his vehicle’s headlights and front grill, but was unable to verify his purported purchase of the replacement parts. The complaint also stated that Carless provided State Farm with a handwritten receipt for upholstery repairs to his vehicle; the receipt was dated June 21, 2018 and reflected a total of $4,137.25. However, investigators allegedly determined that the receipt was fraudulent. Investigators contacted a leaseholder at the Reading address and allegedly learned that Carless had not lived at that location between March and October of 2018, and that his vehicle was not seen there. According to the complaint, State Farm reviewed Carless’ policy and determined that Carless would have paid more than three times the amount of his current premium to insure the vehicle at his Bronx address. State Farm Insurance denied Carless’ claim. Carless was charged with one count of Insurance Fraud (F3), one count of Insurance Fraud (M1) and one count Criminal Attempt/Theft by Deception (F3).
On November 12, 2020, Gino DeJesse was arrested in Lehigh County.  According to the criminal complaint, on January 23, 2018, DeJesse reported to his employer, Thomas Jefferson University Hospital, that he had suffered a workplace injury to his back while exiting an elevator. After several hours of light duty, DeJesse allegedly advised his employer that he was in too much pain to continue working. The complaint stated that DeJesse told medical personnel on several occasions that his pain level was very high and prevented him from working. On, January 23, 2018, DeJesse began to receive total disability Workers’ Compensation benefits from the hospital’s third party Workers’ Compensation benefit administrator, PMA Management Corporation. According to the complaint, on February 16, 2018, DeJesse submitted to his employer two LIBC forms which indicated that he was neither employed nor self-employed. The complaint further stated that during the two-week period in which DeJesse told medical personnel that he was unable to work, investigators observed DeJesse working at his family-owned catering business without exhibiting any noticeable difficulty or pain. According to the complaint, DeJesse received $1,110.12 in total disability Worker’s Compensation benefits, then was fired after the employer learned of the results of the investigation. DeJesse filed a union grievance over his firing and continued to litigate his Workers’ Compensation claim. Ultimately the parties agreed to settle both matters. According to the complaint, the settlement included payment by the employer of a $25,000 lump sum to DeJesse. DeJesse was charged with one count of Theft by Deception (F3), one count of Criminal Use of Communication Facility, and three counts of Workers’ Compensation Fraud (F3).
On November 16, 2020, Julio Martinez was arrested in Berks County.  According to the criminal complaint, Martinez purchased an automobile insurance policy from the CURE Insurance Company on August 29, 2019.  On January 7, 2020, Martinez allegedly called the insurance company and lowered his deductible from $1500.00 to $50.00.  The complaint stated that two days later, Martinez contacted the insurer and filed a deer strike claim. A subsequent investigation allegedly revealed that Martinez had been driving a different vehicle when the deer strike occurred and that the accident happened prior to his policy inception.  CURE denied the claim. Martinez was charged with two counts of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (F3), and one count of Criminal Attempt/Theft by Deception (M1).
On November 9, 2020, Luciano Costa-Miranda was arrested in Chester County.  According to the criminal complaint, on May 6, 2019, at 11:54 AM, Costa-Miranda’s spouse obtained a Progressive Insurance auto policy for several vehicles, including a white 2019 GMC Sierra. Costa-Miranda was listed as an insured driver on the policy. The complaint stated that on May 9, 2019, Progressive received an accident claim from a woman who reported that a white GMC Sierra driven by Costa-Miranda rear-ended her vehicle on May 6, 2019 at 11:20 AM. Progressive then interviewed Costa-Miranda, who allegedly stated that the crash occurred between 1 PM and 2 PM on May 6. According to the complaint, an investigation revealed that at 11:29 AM on May 6, police responded to an accident which involved Costa-Miranda and the other driver. The responding officer allegedly stated that Costa-Miranda did not provide proof of insurance at the accident scene and was cited for operating an unregistered vehicle. The complaint further stated that Costa-Miranda’s insurance agency confirmed that the policy was purchased at 11:54 AM on May 6. Further, an agency employee reportedly recalled that during the policy transaction, Costa-Miranda allegedly mentioned that he had been involved in an accident that morning and asked if the incident would be covered by his new policy. Progressive denied the claim. Costa-Miranda was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).
On November 6, 2020, Naquanda Medley was arrested in Philadelphia County.  According to the criminal complaint, on March 2, 2019, at 10:08 PM, Medley purchased an insurance policy from Safe Auto. On March 4, Medley filed a claim in which she allegedly told the insurer that she had been involved in a two vehicle accident which occurred around midnight on March 3. The complaint stated that Medley told a Safe Auto claims adjuster that she obtained her vehicle policy at approximately 7 PM on March 2 and that her coverage was in place for several hours before the accident occurred. However, the driver of the other vehicle allegedly advised the adjuster that the crash had occurred at 7:00 PM on March 2. According to the complaint, the owner of the other involved vehicle provided the Safe Auto adjuster with photos from the accident scene and a copy of an expired insurance card which Medley allegedly gave to the other driver. According to the complaint, the photos bore the time and date stamp of 7:09 PM on March 2, 2019. Safe Auto determined that the accident had occurred prior to the inception of Medley’s coverage and denied the claim. Medley was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (F3) and one count Insurance Fraud (M1).
On November 3, 2020, Breana Gruetter was charged in Dauphin County.  According to the criminal complaint, Gruetter obtained a homeowner/renter policy from the Strategic Insurance Company on August 20, 2019. On August 23, Gruetter called the insurer and allegedly reported that on the previous day, water had leaked from the ceiling of her home and caused $1000.00 in damage to her television and other personal property. However, the claim further stated that the property’s maintenance supervisor confirmed that the leak had occurred on August 19, which was prior to the inception of Gruetter’s coverage. The claim was denied. Gruetter was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (M1).
On November 4, 2020, Racheal Buza was sentenced in Washington County after entering an open plea to the charge of Criminal Attempt/Theft by Deception (M1). Buza purchased a Progressive Insurance policy for her vehicle on June 29, 2019. On October 10, 2019, the policy was cancelled for non-payment, then was reinstated on October 14. On October 22, Buza filed a claim with Progressive in which she reported that the driver’s side of her vehicle was damaged when it was struck by a hit and run driver on October 19, 2019. A subsequent investigation revealed that Buza filed a similar claim with State Farm in June of 2019 and was paid for the damage to her vehicle. Investigators compared State Farm’s photographs of the vehicle damage with the claim photos taken by Progressive, and determined that the damage was identical. Progressive denied the claim. Buza was sentenced to serve 18 months of probation and ordered to pay all costs.
On November 4, 2020, Riley McCall was sentenced in Lackawanna County. He previously entered a negotiated plea to one count of Insurance Fraud (M1). On August 5, 2019, McCall reported to Progressive Insurance that his vehicle had been damaged by hail on August 2, 2019. An investigation revealed that McCall previously contacted the insurer and reported that the same vehicle had incurred severe hail damage during the evening of May 28. At that time, the Progressive representative advised McCall that the damage was not covered because his policy lacked comprehensive coverage. On July 23, McCall added comprehensive and collision to his vehicle policy and was advised that the coverage would take effect on July 28. The Progressive investigator assigned to McCall’s August 5 hail damage claim consulted area weather data and found that no storms had been reported for the date of August 2. However, the investigator also noted that there had been reports of catastrophic weather across Pennsylvania on May 28 and 29.  Progressive denied McCall’s claim. McCall was sentenced to serve 12 months of probation and ordered to perform 25 hours of community service.
On November 18, 2020, Dustin Crooks was sentenced in Allegheny County after entering a negotiated plea to Criminal Attempt/Theft by Deception (M1). On May 28, 2019, Crooks’ spouse filed a claim with State Farm and advised that her husband, their children and she had been involved in an accident with another State Farm insured vehicle on May 25. During a telephone interview with State Farm, Crooks claimed to have injured his back in the accident. Crooks told the insurer that his doctor advised him to take a week off of work to rest. Crooks claimed that his injuries and the time away from work had caused him to lose $7,000 in earnings. However, an investigation revealed that the accident had occurred while Crooks and his family were vacationing in the Outer Banks and that they had continued their vacation following the accident. Moreover, investigators confirmed that Crooks was unemployed at the time of the accident. Crooks withdrew his claims for pain and suffering and lost wages when State Farm informed him of the investigation. Crooks was sentenced to 18 months of probation and was ordered to pay all costs.
On November 20, 2020, Ivory Pinkett was sentenced in Allegheny County after entering a negotiated plea to one count of Theft by Deception (M1). Pinkett obtained a MetLife Auto & Home Insurance policy through her employer on April 12, 2019. At 2:30 AM on April 14, Pinkett contacted her local police and reported that someone had stolen a pair of boots and a cup of change from inside her vehicle. Pinkett then filed a claim with MetLife in which she reported that various items were stolen from her vehicle while it was parked outside of a bar and restaurant.  Pinkett told the insurer that the theft included pieces of jewelry valued at more than $13,000. When the insurer asked Pinkett to provide proof that she had purchased the items, she submitted receipts for clothing and a scooter. Pinkett told MetLife that she did not have receipts for the jewelry, because those items were inherited or purchased years before. Pinkett submitted photographs of three jewelry pieces to MetLife. Investigators examined the photos and determined that they had been taken on April 22, 2019, approximately one week after Pinkett reported the theft. Pinkett was sentenced to serve 12 months of probation, perform 50 hours of community service and pay all court costs.
(ARD) Dispositions

During the month of November, five additional defendants received Accelerated Rehabilitative Disposition (ARD). 

Anti-Fraud Compliance - Reporting of insurance Fraud to Law Enforcement Agency

Pennsylvania Bulletin Notice 2016-04 (issued April 30, 2016) reminded insurers of their obligations to report suspected arson or insurance fraud to law enforcement agencies within the Commonwealth.  The bulletin also announced a decision by the Pennsylvania Department of Insurance to allow licensees to satisfy their reporting obligation when they electronically submit reports of suspected fraud to the National Insurance Crime Bureau (NICB).
 
On July 6, 2017, Pennsylvania began participating in this online service which enables member companies to electronically forward reports of suspected fraud to the Pennsylvania Office of Attorney General’s Insurance Fraud Section or other appropriate law enforcement agencies at the same time the companies report suspicious claims to the NICB. NOTE: The NICB is not a law enforcement agency. Therefore, a licensee cannot satisfy the fraud reporting requirement by submitting a non-electronic (paper) referral only to the NICB.
 
Important: When utilizing electronic filing through NICB, users should take careful note of the provided instructions regarding the “Party” to a claim.  Information entered about a Party will only be transmitted to law enforcement if users select one of two options: “This Party was subject to an SIU investigation” or “This Party was subject to an enforcement action.”  Some users have missed this notation about individual Party data and consequently have submitted incomplete information to law enforcement.

This newsletter was produced by the PA Office of Attorney General’s Insurance Fraud Section and edited by Senior Deputy Attorney General John T. Dickinson.

Copyright © 2018 Office of Attorney General 
All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.