December Newsletter Ins Co(1)

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INSURANCE FRAUD SECTION NEWSLETTER

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Prison Sentences Handed Down inRate Evasion Insurance Scam

Michael Bozzi, Josh Green, Alex Bien-Aime and Bucks County Insurance pled guilty toeleven counts including Insurance Fraud and Theft by Deception and were sentenced on

November 30, 2009, in Bucks County.

Bozzi was a licensed insurance broker and the owner/operator of Bucks CountyInsurance (BCI). Green, a licensed insurance broker, was an employee of BCI and Bien-Aime is a resident of New York State.

Bozzi and Green devised a scheme to obtain Pennsylvania auto insurance policies forindividuals living in New York City. Most of the policies were obtained from the LincolnGeneral Insurance Company and the American Independent Insurance CompanyBien-Aime advertised using flyers that he could provide inexpensive automobiles andinsurance to individuals. Bien-Aime sold vehicles to these individuals and then would deawith Green and Bozzi to obtain Pennsylvania insurance policies for the vehicles. Green andBozzi electronically submitted hundreds of applications for non-Pennsylvania residents toinsurance companies containing false Pennsylvania addresses. Some of the addressesincluded Bucks County PO Box numbers which belonged to Bien-Aime and anotherindividual. In addition to false addresses, many of the applications also contained falseinformation about the applicant’s driver’s license, prior insurance and whether they owneda home, in order to receive discounts and avoid detection.

The men operated their scam in 2005 and 2006, costing insurance companies morethan $500,000 in rate evasion value. The total amount paid out by the insurancecompanies on claims was $61,856.87.

Bien-Aime, Bozzi, Green and Bucks County Insurance all pled guilty to one count of Conspiracy (F1)four counts of Insurance Fraud (3-F3 & 1-M1) and three counts of Theft by Deception (F3) and were

sentenced on November 30, 2009, to serve incarceration, 5 years consecutive probation and ordered topay restitution of $61,856.87, joint and several, and all court costs. Alexander Bien-Aime was sentencedto serve 11 ½ to 23 months incarceration, Michael Bozzi was sentenced to serve 8 to 23 monthsincarceration and Josh Green was sentenced to serve 3 to 23 months incarceration.

Bucks County Insurance was accessed no further penalty as the company is now defunct and out ofbusiness. Co-defendant, Serge Jeanty pled guilty on July 15, 2009, and was sentenced to serve 36months probation and was ordered to perform 50 hours of community service and pay all court costs.

December 2009



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On November 24, 2009, Jacqueline Miller wasarrested in Westmoreland County. Accordingto the Criminal Complaint, Miller began

collecting long-term disability benefits fromthe Unum Insurance Company. Millerclaimed to have a severe asthmatic conditionthat could not be controlled and rendered herincapable of returning to work. TheComplaint further stated that at the time thebenefits were approved, Miller was told byUnum to list any “deductible sources” of income, including social security benefits andthat none were listed. The Complaint allegedthat Miller was receiving social securitybenefits for herself and her children at thesame time she was collecting disabilitybenefits from Unum. Furthermore, Millerallegedly denied in writing and in telephoneconversations with Unum that she wasreceiving other benefits. Jacqueline Miller hasbeen charged with one count of InsuranceFraud (F3) and one count of Theft byDeception (F3).

On November 13, 2009, Matthew Harter wasarrested in Luzerne County. According to theCriminal Complaint, Harter, a licensedinsurance agent, submitted applications to

the Bankers-Conseco I nsurance Companycontaining false and made-up information forthe sole purpose of obtaining commissionpayments from Bankers-Conseco over a twoyear period. The Company alleged that

Harter received over$10,000 in commissionpayments from Bankers-Conseco that he was notentitled to receive.Matthew Harter has beencharged with one count of Theft by Deception (F3)

and one count of Insurance Fraud (M1).

On November 17, 2009, Carol Wiel wasarrested in Allegheny County. According tothe Criminal Complaint, Wiel had purchased asickness policy with the CombinedInsurance Company which would pay her$40 per day for inpatient hospital stays. Wiel

subsequently filed a claimwith the CombinedInsurance Company forbenefits resulting fromhospital stays at theUniversity of PittsburghMedical Center (UPMC)

between February 5, 2007and January 27, 2009 andsubmitted paperwork tosubstantiate her claim. Allegedly, Wiereceived inpatient benefits for 226 days whenshe was not receiving inpatient care andfabricated the paperwork to verify those datesof inpatient care. As a result, Wiel receivedbenefits in excess of $9,000 to which she wasnot entitled. Carol Wiel has been chargedwith one count of Insurance Fraud (F3) andone count of Theft by Deception (F3).

On November 16, 2009, SheldonHigginbotham was arrested in AlleghenyCounty. According to the Criminal ComplaintHigginbotham filed a claim with theTravelers Insurance Company allegingthat in November 2008, he sustained bodilyinjury as a result of a slip and fall at theDoubletree Hotel in downtown PittsburghHowever, according to the CriminaComplaint, videotape evidence andeyewitness testimony revealed thatHigginbotham did not slip and fall as he

claimed. Sheldon Higginbotham has beencharged with one count of Insurance Fraud(F3) and one count of Criminal Attempt/Theftby Deception (F3).

On November 30, 2009, Brian Ahearn wasarrested in Allegheny County. According tothe Criminal Complaint, Ahearn wasuninsured at the time of a two-car accidentImmediately after the accident, Ahearnobtained an automobile policy on-line with theEsurance Insurance Company and failed todisclose the accident that had occurred that

day. Furthermore, the Complaint alleges thatAhearn then reported to the insurer of theother driver that he was insured by Esuranceat the time of the accident in an attempt toget Esurance benefits. Brian Ahearn has beencharged with two counts of Insurance Fraud(F3 & M1) and one count of CriminaAttempt/Theft (M1).



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On November 25, 2009, Joseph Masucci wasarrested in Allegheny County. According tothe Criminal Complaint, Masucci worked as anagent for the Bankers Life and CasualtyCompany. In 2008, Masucci allegedly forgedand submitted at least five applications forinsurance policies in the names of existing

policyholders for the purpose of obtainingadditional commissions from the insurer.Additionally, Masucci allegedly used bankaccount information on file with Bankers Lifeand Casualty to arrange for the payment of premiums on these policies with automateddeductions from the bank accounts of theunwitting policyholders. Joseph Masucci hasbeen charged with two counts of Forgery(F3), one count of Insurance Fraud (M1), onecount of Theft by Deception (M1) and onecount of Identity Theft (M1).

On November 30, 2009, Christina Wilmer wasarrested in Delaware County. According tothe Criminal Complaint, Wilmer obtained apolicy from the State Farm InsuranceCompany that would pay $100 for each dayof hospitalization for any member of Wilmer’sfamily. The Complaint stated that Wilmersubmitted claims for four days of hospitalization for her husband, allegedlyoccurring after she obtained the policy.However, according to the CriminalComplaint, Wilmer’s husband’s treatments

actually occurred before the date of the policyinception. Additionally, the Complaint allegesthat Wilmer altered the dates on the hospitalbills that she submitted to State Farm tosubstantiate her claim. Christina Wilmer hasbeen charged with one count of InsuranceFraud (F3), one count of Forgery M1) and onecount of Criminal Attempt/Theft by Deception(M1).

Aaron Anderson and Vincent Grimm pledguilty to one count of Theft by UnlawfulTaking or Disposition (M1) in WestmorelandCounty. Aaron Anderson arranged with theowner of a vehicle to take the vehicle so thatthe owner could receive insurance proceedsfrom the Progressive Insurance Company.Anderson then enlisted the services of Grimm

to assist in taking the vehicle and then Grimmagreed to maintain possession of the vehiclein his garage. On November 16, 2009, AaronAnderson was sentenced to serve 3 yearsprobation and ordered to perform 30 hours ofcommunity service and pay a fine of $300and all court costs. On November 19, 2009

Vincent Grimm was sentenced to serve 2years probation and ordered to perform 30hours of community service and pay all courtcosts.

Jerry Newman pled guilty to one count ofTheft by Deception (M1) and one count ofFalse Reports to Law Enforcement (M3) inDelaware County. Newman arranged to havehis vehicle stolen and then falsely reportedthe theft to the police and submitted a claimto the Travelers Insurance CompanyNewman’s vehicle and keys were recoveredinside a container on board a ship set to saito Liberia. On November 9, 2009, JerryNewman was sentenced to serve 2 yearsprobation, ordered to perform 100 hours ofcommunity service and to pay a fine of$1,000, restitution and all court costs.

Tammy Remphrey pled guilty to one count ofTheft by Deception (M1) in Schuylkill CountyRemphrey was injured while employed as anEMT for the Berwick Area AmbulanceAssociation. Remphrey returned to full-time

duty but continued to collect $13,823.18 inworkers’ compensation benefits from theState Workers’ Insurance Fund. Whilecontinuing to draw benefits Remphreysubsequently resigned her job, moved toSchuylkill County and obtained newemployment. Remphrey also submitted aform to SWIF falsely claiming that she hadnot worked since she began to collectdisability benefits. On November 25, 2009Tammy Remphrey was sentenced to serve 2years probation and ordered to perform 50hours of community service, pay a fine o

$250, restitution and all court costs.

(ARD) DISPOSITIONS

During the month of November, sevenadditional defendants received AcceleratedRehabilitative Disposition (ARD).

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December Newsletter Ins Co(1)