Utah Insurance Department Fraud Division FY2014 Annual Report

Transcription

1 Utah Insurance Department Fraud Division FY2014 Annual Report

2 MISSION STATEMENT The Insurance Fraud Division acts as the primary law enforcement agency in the State of Utah for investigating suspected fraudulent insurance claims. The core mission of the Insurance Fraud Division is to protect the public from economic loss and distress. We do this by actively investigating, prosecuting and seeking restitution from those who commit insurance fraud. We further seek to deter insurance fraud through active public awareness education. Insurance Commissioner: Todd Kiser Fraud Division Director: Armand A. Glick 2

3 Fraud Director s Message The enclosed annual report provides an informative look at the efforts, accomplishments, and challenges of the Utah Insurance Department Fraud Division for Fiscal Year I am very proud of the efforts of the Fraud Division and feel we have one of the most effective and successful insurance fraud investigative units in the nation. I am also proud of the continued collaboration and working relationship between the fraud division, insurance company special investigative units, local and federal law enforcement, the National Insurance Crime Bureau. Collaboration with these partners is crucial for our overall success. Funding for the Insurance Fraud Division primarily comes through assessment to insurers who operate in the State of Utah. This assessment is based on total premium sold in the prior year by each company. There are close to 1,600 companies licensed to sell insurance in the State. I appreciate the support we received from these insurance companies in their support of increasing the fraud assessment through the state legislature in As a result the Fraud Division s annual assessment in FY 2014 was approximately $1,900,000. In addition to the assessment, the Insurance Fraud Division, is authorized by state statute to recover the costs of our investigations from the defendants we prosecute. Unfortunately, insurance fraud continues to be a crime that is accepted by many as a way to make financial gain. Many feel that insurance companies are just big businesses and that lying on a claim is ok since they have been paying for their insurance for years without ever filing a claim. Others simply look to insurance as an easy target for their criminal activities. Every resident of the State of Utah is adversely affected by insurance fraud in some way. Some studies believe that each family pays more than $1,000 annually in increased insurance premiums due to insurance fraud. It is the goal of the Insurance Fraud Division to aggressively investigate and prosecute offenders in an effort to reduce the cost of insurance fraud in the State of Utah to our citizens. Due to support of the Insurance Industry, we have been able to hire an additional prosecutor as well as an investigator. With the increase in staff I look forward to our enhanced ability to investigate and prosecute offenders in our effort to deter insurance fraud, facilitate financial recovery, and reduce the affects of fraud on the citizens of Utah. Sincerely, Armand A. Glick Director, Insurance Fraud Division Utah Insurance Department 3

4 Department of Insurance - Overview The Utah Insurance Department is the state regulatory authority for the insurance industry and is responsible for enforcing all insurance-related laws of the State of Utah. The Mission of the Utah Insurance Department is to foster a healthy insurance market by promoting fair and reasonable practices that ensure available, affordable and reliable insurance products and services. The mission of the Department will be accomplished by educating, serving and protecting consumers, governmental agencies, and insurance industry participants at a reasonable cost. We cooperate with and serve state and other governmental agencies in fulfilling these responsibilities. While one of the Department s objectives is to investigate regulatory violations, the Department s Fraud Division was created in 1996 with the mission of investigating criminal insurance fraud. The Insurance Fraud Division investigators are Utah POST certified Special Function Police Officers. The Fraud Division works closely with insurance company investigators, local law enforcement, federal law enforcement, private non-profit organizations such as the National Insurance Crime Bureau (NICB), as well as state and federal prosecutors to bring both consumer and industry offenders to justice. Incoming cases, tips, and complaints of possible fraud are received from a variety of sources. Most cases are received through the National Insurance Crime Bureau (NICB), Special Investigative Units (SIU) within the insurance industry, other law enforcement agencies, and citizens. When a tip or complaint is received, it is reviewed to determine whether further investigation is merited. Cases are then assigned to an investigator who pursues all possible leads, conducts interviews, and gathers evidence. When the investigation is complete, the investigator presents the case to the Attorney Generals Office which is contracted to provide dedicated attorneys to prosecute insurance fraud. These attorneys are housed in the same offices with the fraud investigators. This coordinated approach results in greater success in case prosecution and resolution. 4

5 What is Insurance Fraud? Insurance fraud happens when people deceive an insurance company in an effort to collect money to which they aren t entitled. Insurance Fraud is the second most costly white-collar crime in America, behind tax evasion. Insurance industry studies indicate that 10 % or more of property and casualty claims are fraudulent. The National Health Care Anti-Fraud Association conservatively estimates that 3% or $70 Billion is lost to health care fraud each year. Other law enforcement estimates place this as high as 10% or $234 Billion annually. The Coalition Against Insurance Fraud estimates that insurance fraud costs Americans more than $96 Billion annually. The Coalition also believes that up to 30% of a policy holder s insurance premium is due to charges added to cover industry losses from insurance fraud. Insurance fraud is typically committed by consumers, insurers, or service providers. A few general examples are as follows: Consumer Fraud: Adding items to a legitimate theft claim that were not stolen; obtaining insurance after an accident and claiming the accident occurred while insured; abandoning a vehicle and then reporting it stolen; staging an auto accident using a previously damaged vehicle and claiming the damage is all new; exaggerating injuries to receive treatment or compensation; lying about the number of drivers in your home on an application for insurance; creating false receipts to obtain replacement value on the claim; or doctor shopping for narcotics that are not medically necessary. Insurer Fraud: Agents selling false insurance policies; keeping the policy holder s premium payments and not forwarding them to pay for the policy; or agents fraudulently using personal information belonging to someone else to obtain a better premium quote for the applicant. Provider Fraud: Health care providers, contractors, and others may artificially inflate their billings to insurance; a dentist may bill for high noble metals while using a lower grade material for a crown; a doctor may proscribe a treatment that is not medically necessary; or a roofer damages or removes more shingles in order to create enough damage for insurance to cover replacing the entire roof. 5

6 Insurance Fraud Partnerships The Insurance Fraud Division works closely with many different partners in the fight against insurance fraud. Some of these include the public, insurance companies, the National Insurance Crime Bureau (NICB), the Coalition Against Insurance Fraud, other state and local police agencies, as well as many different federal agencies such as the FBI and Health and Human Services. Our cooperative effort with the Utah Attorney General s Office creates an opportunity to have three assistant attorneys general assigned exclusively to the Insurance Fraud Division. Having dedicated attorneys means they understand the complexities of insurance fraud, and are able to focus their entire efforts in prosecuting this type of crime. Every other month the Insurance Fraud Division, with the assistance of NICB, hosts an information sharing meeting with investigators from the health insurance sector, the property and casualty insurance sector, the Medicaid Fraud Task Force, the FBI, and other criminal investigative agencies. These meetings serve to bring awareness to criminal trends, identify subjects who file claims with multiple insurance companies, and reduce loss from emerging fraud schemes. 6

7 Insurance Fraud Division Organization The Insurance Fraud Division consists of the director, ten criminal investigators and three support staff. In addition the IFD contracts with the Utah Attorney General s Office for three assistant attorneys general who prosecute all criminal cases for the IFD. Director Armand Glick Information Specialist LuAnne Winters Legal Secretary Lisa Peterson Legal Secretary Nikki Cardwell Assistant Attorney General Daryl Bell Deputy Director Reed Kartchner Deputy Director Dwight Christensen Assistant Attorney General Shelley Coudreaut Assistant Attorney General Alex Goble Investigator Steven Jentzsch Investigator Jeffrey Remus Investigator Daniel Rodriguez Investigator Ned Shimizu Investigator Rudy VanBeekum Investigator Brett DeCow Investigator Vacant Investigator Ryan Evans 7

8 Legislative Actions 2014 brought two important changes in statute regarding the Insurance Fraud Division. First, the State Legislature created a non-lapsing restricted fund for handling victim restitution payments. Prior to this change, the IFD had to forecast anticipated restitution collections and build these funds into the IFD revenue budget for approval to expend in the coming year. This created the potential that if more restitution was collected than was anticipated, there may be a lack of approval for the IFD to process the funds to issue a restitution check to the victim. The new fund allows for pass through of these funds from the defendant to the victim without a set budget constraint. Since the fund is restricted, it can only be used for these funds. Second, investigators with the Insurance Fraud Division are currently sworn Special Function Officers with full law enforcement authority while on duty. However they are currently prohibited in participating in the public safety retirement system. The Legislature altered existing statute to allow investigators from the Insurance Fraud Division to be certified as full law enforcement officers and to participate in the public safety retirement system. This change was made in an effort to enable better recruitment and retention of extremely qualified investigators by the Division. These changes were permissive in their enactment and we are pending necessary approvals to make these changes. 8

9 Referral Trends Referrals to the Insurance Fraud Division continue to increase. In 2009 we saw a significant increase in referrals due to a new Mandatory Reporting Law. This law requires insurers to report suspected insurance fraud to the Insurance Department. Since the passage of this law and the initial increase, referrals have remained relatively steady for the past five years. Historically the Insurance Fraud Division has only tracked the number of defendants charged. Typically one incident of insurance fraud resulted in one defendant being charged. In recent years we have seen an increase in offenders who commit many more than just one instance of insurance fraud. Several cases in FY2013 and FY2014 involved defendants who committed fraud in filing several dozen separate false insurance claims. It is interesting to note the difference between the number of defendants prosecuted and the number of cases prosecuted in the chart below. One additional note: In many instances it has proven impossible to accurately track the number of false insurance claims a defendant has been charged with. Some exceed several hundred, as in the instance of false glass repair scams. In these cases only one or two cases were counted toward the statistics shown below FY2010 FY2011 FY2012 FY2013 FY2014 Referalls Received Referalls Assigned Referralls Closed Cases Prosecuted Defendants Prosecuted 9

10 FY 2014 Referrals By Type Total Referrals 787 Agent Fraud 41 False Property The 29 Applica on Fraud 34 False Auto The 38 Healthcare 30 Staged Collisions 20 Exaggerated Injuries 38 Vehicle Arson 1 Doctor Shopping 8 Inflated Loss/Damages 29 Prior Injuries 3 False Damages 14 Slip and Fall 11 Property & Casualty Other 385 Other 76 Agent Fraud Application Fraud HealthCare Exaggerated Injuries False Property Thefts Fasle Auto Thefts Staged Accidents Inflated Loss/Damages Property & Casualty Misc 10

11 Charges Filed Overview In Fiscal Year 2014 the Insurance Fraud Division filed criminal charges against 75 defendants who were involved in more than 120 insurance fraud incidents. A total of 398 charges were filed. In most instances defendants were charged with multiple counts based on the criminal actions they committed. It should be noted that there were a few defendants involved in several hundred false glass claims. These are not reflected in the 120 insurance fraud incidents identified above. The most common charges filed in Fiscal Year 2014 are shown in the chart below Felony 1 Felony 2 Felony 3 Misdemeanor A Misdemeanor B 0 11

12 Restitution Collected The Insurance Fraud Division collects and tracks restitution paid in the cases prosecuted by the Division. The Division processes and accounts for the payments and issues payment to the appropriate victims in each case. In FY2014 the IFD collected and distributed to victims of insurance fraud $395,907. In cases prosecuted federally, restitution is not paid through the Division and is captured as outside restitution. In these cases where outside restitution has been verified it has been included below. The Insurance Fraud Division issues restitution payments to victims first before collecting the investigative costs from those convicted of insurance fraud. $700,000 Insurance Fraud Division Restitution Recovery Trend Chart $621,778 $600,000 $516,928 $500,000 $409,702 $395,907 $400,000 $300,000 Victim Restitution Investigative Costs Outside Restitution $249,880 $248,516 $201,535 $200,000 $100,000 $102,260 $84,769 $83,367 $105,847 $2,981 $

13 Workers Compensation Fund Claims There are several insurers who provide workers compensation insurance coverage to employers in the State of Utah. Many of these companies refer suspected incidents of fraud to the Insurance Fraud Division for investigation and prosecution. One notable exception is the Workers Compensation Fund of Utah (WCF). The Workers Compensation Fund of Utah primarily submits their completed investigations to the local District Attorney s Office for prosecution. In an effort to avoid under reporting the impact of workers compensation fraud in the State, the WCF has provided the following statistics to the IFD for inclusion in this report. The following statistics represent the last half of fiscal year 2014 as they only include data from January to June of During this period of time the WCF initiated 216 investigations of suspected insurance fraud. During this same period the WCF submitted 18 cases for criminal prosecution. One statistic that is not typically available to the Insurance Fraud Division is the estimated amount that was saved due to an investigation by the insurance company that identifies fraud. In the case of the Workers Compensation Fund of Utah, they report that their investigations resulted in a savings of their reserves in the amount of $3,102,602. This is the amount that WCF would have paid had the fraud not been discovered. Insurance company fraud units are critical to uncovering insurance fraud. Even if a case does not meet a criminal burden of proof and cannot be criminally prosecuted, these investigative units may be able to stop undue payments to those who knowingly file false or misleading claims. This affects all of us by helping limit the impact false claims have on the premiums each of us pay. 13

14 Major Case Highlight Staged Vehicle Burglaries State vs. Sullivan Over a period of six months, Sullivan purchased several auto, homeowners, and travel insurance policies. With these policies in place Sullivan traveled to his home state of Iowa three different times. While in Iowa, Sullivan rented vehicles, broke out a window, and filed false burglary reports with the local police departments. Sullivan then submitted dozens of false vehicle burglary claims for items that were never taken. Sullivan claimed to have had no prior loss claims and denied any other insurance policies. He provided false property receipts as proof of ownership. In total, Sullivan filed 26 false loss claims with over a dozen insurance companies. He was successful in obtaining over $65,000 in a short period of time. In addition to the false vehicle burglary claims, Sullivan also filed false claims for lost luggage, residential burglary, auto glass breakage, lost or stolen mail orders, and lost credit cards for credit cards he obtained through identity theft. Sullivan spent nearly a year in jail and upon his release he immediately reengaged in criminal activity. He obtained credit cards in his mothers name without her knowledge. He then used these credit cards and impersonated her while filing lost or stolen credit card claims to get the accounts credited over $20,000 that he spent in just two months. The total loss incurred during the four months he was out of jail exceeded $40,000. Sullivan was re-arrested as he appeared to be starting a new scheme in selling items on EBay that he did not have; purchasing shipping labels; and then filing lost mail claims when the customers failed to receive the packages he never sent. Sullivan was convicted on 32 felony offenses including racketeering, money laundering, insurance fraud, identity theft, financial crimes, and others. He was sentenced to three consecutive 1-15 year prison terms and ordered to repay over $100,000 in restitution. 14

15 Major Case Highlight False Medical Billing Scheme State vs. McCusker Between 2007 and 2013, Dr. Charles McCusker, a prominent psychologist, operated practices known as Health Balance International, LLC, and New Life Balance, LLC located in Salt Lake City, Utah. During this period of time, McCusker engaged in a false billing scheme where he billed over $2.3 million dollars for services he never provided to patients. McCusker obtained personal and medical insurance information from persons he provided a small piece of medical equipment to, but whom he had never seen or provided any other service to. In one instance McCusker enlisted an ex-spouse of a patient he had never seen to provide information and to conceal the fraudulent bills. Both the alleged patient, and the ex-spouse have since passed away. McCusker used this information to bill several insurance companies for daily psychological services he never provided to these patients. This case was jointly investigated by the Insurance Fraud Division and investigators from the FBI and Health and Human Services. While this first investigation was pending, and despite McCusker knowing he was awaiting federal charges, McCusker engaged in new acts of billing fraud with two additional health insurance agencies. As a result, a new investigation was opened and charges were filed in the State Courts. McCusker was ultimately charged in State Court with Racketeering, a 2nd degree felony; 12 counts of Insurance Fraud, all 2nd degree felonies; and 12 counts of Identity Fraud, all 2nd degree felonies. McCusker was also indicted in Federal Court on 18 counts of Health Care Fraud and 16 counts of Mail Fraud. The two cases are likely to be pursued jointly under the Federal Prosecution. The Federal case is proceeding. 15

16 Major Case Highlight Utah County Staged Accident Ring State vs. Sueldo Sueldo owned JC Auto body in Provo Utah. Sueldo enlisted over eight others whom he came in contact with through his dealings in the community. Sueldo devised a scheme to purchase cars from immigrants who were leaving the United States to move back to Central and South America. Sueldo kept the vehicles registered in the previous owners names and enlisted his co-conspirators to maintain or obtain new auto insurance while impersonating the previous auto owners. Sueldo then intentionally caused damage to these vehicles at his body shop and had his co-conspirators file false auto accident claims. When the false accidents were reported to various insurance companies, the appraisers would be sent to JC Auto Body to inspect the vehicles. Sueldo would then submit false vehicle repair and car rental invoices from JC Auto Body to the insurance companies for payment. No car rentals were ever provided and the vehicles were never repaired and were used several times in false accident claims. Sueldo was very successful in his scheme due to the involvement of his body shop. He filed over 21 false accident claims involving more that 19 different vehicles and stole the identity of more than 11 prior vehicle owners. Sueldo obtained over $110,000 in insurance payments from his staged accident scheme. While engaged in his scheme, Sueldo routinely traveled back and forth between Bolivia and the United States. Prior to the Insurance Fraud Division completing their investigation, Sueldo left for Bolivia for the last time. He left his family in the United States with the intention of never coming back. Eight of his co-conspirators were arrested and his body shop was seized. Ultimately $100,000 in bail was turned over to pay victim restitution in exchange for the body shop being released to family members he left in the United States. Sueldo remains a fugitive at this time. 16

17 Major Case Highlight Summit County Staged Accident Ring State vs. Ibarra Ibarra enlisted more that a dozen others in his staged accident scheme. He utilized his position he held at work, church, and the community to entice others to participate in his scheme. Ibarra used more than 25 different vehicles and his dozen co-conspirators to file at least 65 false auto accident claims. The scheme s claims exceeded $200,000 with a little more than $100,000 being paid out by more than 15 different insurance companies. Ibarra and his co-conspirators took turns obtaining insurance through several different companies. The vehicles and co-conspirators were rotated as drivers to create dozens of different accident scenarios in filing the claims. Nearly all accidents were single vehicle accidents involving animals. Those that involved two vehicles allegedly occurred as a result of one drivers attempt to avoid striking an animal or they occurred in parking lots. Salvaged vehicles were most commonly used with prior damages which was added to for future claims. Most accidents were completely fabricated while in a few instances the co-conspirators actually ran the cars into each other while driving on the road to create more realistic damages. Eleven of the thirteen suspects were arrested in a two day sweep. Many have already pled guilty while others are pending trail and possible deportation. 17

18 Prosecution Summaries The following pages provide a summary of the cases in which criminal charges were filed in Fiscal Year A few of these cases are still pending completion of the judicial process and have not yet resulted in convictions or other dispositions. The monetary values listed for these cases represent the actual loss or the attempted claim amount in the case. 18

19 STATE vs. FOSTER Filing Date: 7/18/2013 Charges Filed: Allstate: $5,000 Insurance Fraud, 2 counts, Felony 3 Tri Care: $Unknown Prescription Fraud, 1 count, Felony 3 False Loss Claims/Doctor Shopping: In September of 2011 Foster claimed to have lost her wedding ring at a restaurant. A few months later Foster claimed to have had her car broken into. Then in 2012 Foster alleged her home was broken into. Foster filed several insurance claims in regards to these incidents. Evidence was discovered that these claims were false. During the investigation Foster was also discovered to have been doctor shopping for controlled substances. Foster used both her married and maiden name to obtain 174 prescriptions from 35 different medical providers between 2009 and Foster pled guilty to Insurance Fraud and was ordered to pay $2,404 to Allstate and $1,000 for investigation costs and to serve 50 hours of community service and a 36 month probation. STATE vs. ENRIQUEZ Filing Date: 7/23/2013 Charges Filed: Farmers: $882 Insurance Fraud, 1 count, Misdemeanor B Staged Accident Claim: In June of 2012, Enriquez was involved in an accident in which his 2006 Impala was hit from behind. A claim was paid by State Farm insurance. In February of 2013, Enriquez claimed to have been hit by another motorist whom he followed to a parking lot demanding her insurance information. The other motorist maintained that she never hit Enriquez who claimed to have been injured. Enriquez filed a damage and injury claim with Farmers. The damage was discovered to be the same from the prior accident. A warrant of arrest has been issued for Enriquez. 19

20 STATE vs. VANARSDALE Filing Date: 7/30/2013 Charges Filed: Prescription Fraud, 4 counts, Felony 3 Forged Prescriptions: A doctor upon running a check on prescriptions prescribed by him, discovered irregularities. The investigation discovered that one of his office staff, Hills, had been calling in unauthorized prescriptions for herself and others, including VanArsdale who picked up several of the forged prescription medications. VanArsdale pled guilty to two counts of prescription fraud and was sentenced to 18 months probation and a fine of $600. STATE vs. ESCALANTE Filing Date: 8/20/2013 Charges Filed: Assurant: $12,921 Insurance Fraud, 1 count, Felony 2 Past Posting of Flood Damage: In January of 2013, a water pipe broke in an apartment rented by the Alsaisaban and flooded his and two other apartments. Alsisaban conspired with the apartment manager, Escalante and his wife to obtain insurance after the fact to pay for the damages. Alsaisaban obtained insurance and then filed a claim alleging the damage occurred after the insurance policy had been in place. Escalante and his wife both pled guilty to insurance fraud. They were sentenced to 24 months of probation and ordered to pay over $1,300 in fines and restitution. 20

21 STATE vs. ALSAISABAN Filing Date: 8/20/2013 Charges Filed: Assurant: $12,921 Insurance Fraud, 1 count, Felony 2 Past Posting of Flood Damage: In January of 2013, a water pipe broke in an apartment rented by the Alsaisaban and flooded his and two other apartments. Alsaisaban conspired with the apartment manager, Escalante and his wife to obtain insurance after the fact to pay for the damages. Alsaisaban obtained insurance and then filed a claim alleging the damage occurred after the insurance policy had been in place. Alsaisaban pled guilty to insurance fraud and was sentenced to 24 months probation and ordered to pay over $1,300 in fines and restitution. STATE vs. HILLS Filing Date: 8/21/2013 Charges Filed: BCBS: Unknown Pattern of Unlawful Activity, Felony 2 Medicaid: $387 Identity Fraud, 5 counts, Felony 3 Prescription Fraud, 3 counts, Felony 3 Insurance Fraud, 2 counts, Misdemeanor A Forged Prescriptions: A doctor upon running a check on prescriptions prescribed by him, discovered irregularities. The investigation discovered that one of his office staff, Hills, had been calling in unauthorized prescriptions for herself and others. Hills used her insurance card to obtain a discounted rate and Medicaid to pay for the narcotics. Hills pled guilty to Identity Fraud, Prescription Fraud, and Insurance Fraud and was sentenced to 45 days in jail and ordered to pay over $1,800 in restitution and fines. 21

22 STATE vs. NEZ Filing Date: 8/21/2013 Charges Filed: Prescription Fraud, Felony 3 Insurance Fraud, Misdemeanor A Forged Prescriptions: A doctor upon running a check on prescriptions prescribed by him, discovered irregularities. The investigation discovered that one of his office staff, Hills, had been calling in unauthorized prescriptions for herself and others, including Nez and his wife who both picked up several of the forged prescription medications. Nez and his wife both pled guilty to Prescription Fraud and was sentenced to 36 months probation, 50 hours community service, and a fine and restitution of $1,000 STATE vs. WILDE Filing Date: 8/21/2013 Charges Filed: Medicaid: Unknown Prescription Fraud, 3 counts, Felony 3 Insurance Fraud, 3 counts, Misdemeanor B Forged Prescriptions: A doctor upon running a check on prescriptions prescribed by him, discovered irregularities. The investigation discovered that one of his office staff, Hills, had been calling in unauthorized prescriptions for herself and others, including Wilde who picked up several of the forged prescription medications. Wilde pled guilty to prescription fraud and was sentenced to 36 months probation, and ordered to pay over $1,200 in restitution and fines. 22

23 STATE vs. MICHEL Filing Date: 8/21/2013 Charges Filed: Medicaid: Unknown Prescription Fraud, 6 counts, Felony 3 Insurance Fraud, 5 counts, Misdemeanor A Forged Prescriptions: A doctor upon running a check on prescriptions prescribed by him, discovered irregularities. The investigation discovered that one of his office staff, Hills, had been calling in unauthorized prescriptions for herself and others, including Michel who picked up several of the forged prescription medications. Case Pending STATE vs. AVILA Filing Date: 8/21/2013 Charges Filed: American Family: $9,091 Insurance Fraud, 3 counts, Misdemeanor A False Vehicle Accidents: In July of 2012, Avila s 1999 Dodge Caravan was hit from behind by another vehicle. Farmers insurance paid for this damage. In October of 2012 Avila applied for insurance with American Family and then filed three additional claims over a period of three months alleging his Dodge had been hit in a parking lot or damaged in a car wash. All three claims were fraudulent and payment was denied. Avila pled guilty to Insurance Fraud and was sentenced to 12 month probation and ordered to pay restitution and fines. 23