Editor’s Note: This is part 2 of a two-part series.
Fraudsters operate under the mistaken belief that they are smarter than the average person and are unlikely to be caught perpetrating their brand of creative financing.
However, the Hall of Shame shines a national public spotlight on the damage these individuals enact. The Coalition Against Insurance Fraud estimates that their damaging crime sprees steal $308.6 billion every year. Fraud drives up premiums for millions of honest, hard-working Americans. People also are maimed, killed and driven to despair when they’re victimized by fraudsters they trusted.
Part 1 of this series introduced readers to a dentist who took his wife on safari to hunt her, an Army veteran who defrauded the government to the tune of $1 million, and a high school basketball coach and an attorney who filed false injury claims before committing suicide. This installment introduces readers to an equally exceptional group of fraudsters.
Toothless tooth con.
A dentist in the Milwaukee area broke patients’ teeth so he could falsely bill insurers $4.2 million for new crowns. Scott Charmoli of Grafton, Wisc., convinced patients they needed crowns, then deliberately ruined their teeth with his dental drill (ugh, just thinking about that sound makes people cringe) and captured photos of the damaged teeth (his own twisted masterpiece) and took X-rays of the damage.
The greedy scheme played out by Charmoli first showing the patients an X-ray of a healthy tooth but then pointing to a line or a spot he said showed a “fracture” or “decay.” He then pressed the patients into agreeing to get a crown to fix the problem. The images of the teeth purposely damaged by him were sent to insurers as he sought payment for every crown performed. Insurers believed the images were real and showed pre-operation damage, so they paid the submitted claims. Many of his patients also paid large co-pays, adding to his pockets.
Reportedly, some of his patients were vulnerable individuals who were either involved in abusive relationships, recently widowed or survivors of cancer, meaning that many were scrounging paycheck to paycheck to afford the ridiculously hyped-up copays he charged them. The scheming dentist persuaded one patient named Todd Tedeschi to get two crowns in one sitting (who does that?!), even though his teeth seemed fine. In total, the unscrupulous dentist Charmoli performed over 700 procedures a year from 2016 to 2019 or approximately 2,100 crowns — he was at around the 95th percentile among dentists in the whole state. Charmoli received four-and-a-half years in prison. Let’s see him chew on that!
Urine becomes yellow gold.
Two men bought small, struggling hospitals and then used them as pipelines for billing insurers for $1.4 billion of false urine tests. Even outside the city limits, healthcare fraud attracts the worst of the worst. Rural hospitals were ideal targets for the not-so-good intentional takeovers in Florida, Georgia, and Mississippi, by Jorge and Ricardo Perez. The hospitals they set their greedy sights on could charge insurers higher rates under agreements to “better serve” rural communities and it is a shame that they took that as an opportunity to execute their fraudulent behavior.
Overall, the Perez brothers converted the rural hospitals into testing labs to bill insurers for phantom or inflated urine tests. The scheme made the hospitals appear to be legit facilities for the testing of urine of addicted patients. The sad reality is that other labs actually did the testing. Much of the lab testing billed through the rural hospitals involved unnecessary urine drug testing for vulnerable addiction treatment patients.
Much too often patients were recruited through kickbacks paid to recruiters and med providers — frequently at sober homes or substance abuse treatment facilities. After private insurers began to question the bills, the Perezes moved on to another rural hospital to begin their sleazy profit scheme again. They always left the one they took over in the same or even a worse financial state as before. The results of these two sleazeballs is that three out of four rural hospitals they drained closed shortly thereafter. The Perez brothers were convicted and will be federally sentenced later.
Slip & fall ring tumbles.
A surgeon performed worthless and unneeded back surgeries on homeless and addicted people so a slip-and-fall ring could exploit them to maximize $31 million of insurance payouts. Dr. Sady Ribeiro pled guilty. The ring recruited more than 400 patients in the New York City area and they were coached to lie that they tripped, fell and were hurt at pre-set locations.
Sometimes they deliberately fell at sites such as cellar doors, cracks in concrete sidewalks and purported “potholes.” The supposedly injured patients were referred to colluding personal-injury attorneys, who falsely sued the site owners and their insurers. The patients were also told to receive ongoing chiro and other treatment from certain chiropractors and doctors, including Ribeiro. To continue with their lawsuits, the patients had to undergo two back surgeries.
They were paid token sums $1,000-$1,500 after they completed surgery. The patients were desperate — addicted or recruited from homeless shelters. Many had to ask for food when they met with the lawyers. Often, they didn’t have clothing to stay warm during the winter. Litigation-funding companies financed the fraudulent lawsuits. “I will play a very honest ‘game’ with you. … I see the patient and I generate a very good dictation that justifies the treatment — there is a cost for that and I hope a profit,” Ribeiro emailed litigation-funding attorney Adrian Alexander. Ribeiro will serve up to five years and must forfeit $513,000. Alexander earlier pled guilty and could receive five years when sentenced. This was one time not to do what the doctor told you.
Fraud of the living dead?
Some $17 million was falsely billed for medical equipment ordered by hundreds of people who turned out to be dead. A Raleigh, N.C. woman named Tanya Parrish Grant included a whopping 422 dead people in her bills. She reached out across the globe and paid firms in India and Pakistan to give her lists of Medicare patient names and personal identifiers. The lists came from overseas call centers that contacted Medicare patients to ask if they needed the equipment. Grant’s firms — Carolina Rehab Produces and Atlantic Brace — then turned around and billed Medicare.
She charged Medicare without actually having physician orders and without shipping any of the products. Patients who received equipment and sent them back never triggered her to reimburse Medicare for the gear, solidifying her greed.
When it came to being audited by Medicare contractors, Grant forged physician orders if no orders existed in her files. She used the money to buy a home near Raleigh; a townhome in Ft. Lauderdale; a Porsche and several Land Rovers. She also amassed more than $1 million in cash and investments. She pled guilty and will spend up to 10 years in prison when sentenced.
Yanking a contractor’s welcome mat.
Thousands of homeowners lost everything when the Tubbs wildfire barreled through Sonoma County, Calif., in 2017. Then along came contractor Salvador Chiaramonte. He took more than $1 million of victims’ money and left them with unrepaired homes. The fire wrecked 4,600 homes. Victims signed about 40 construction contracts with Chiaramonte. He took money for work that was shoddily performed or not done at all. Chiaramonte missed deadlines, and broke promises on construction start dates. Victims saw their rebuilds drag on with no progress. One victim was D.M. Kelley, who lost his house. He met with Chiaramonte who repeatedly mentioned his Christian values.
Chiaramonte took over $100,000 from Kelley and did almost no work. Kelley demanded his money back. Chiaramonte said he needed the money to save his own home. “I said, ‘What about us? We have no houses!” Kelley retorted. Chiaramonte pled no contest and faces a six-year jail term, including 18 months of probation.
Meanwhile, some of Chiaramonte’s victims still haven’t rebuilt their homes with their insurance money stolen. “A lot of them are still very emotionally raw,” says attorney Rich Freeman, who represents 14 homeowners in a lawsuit. “The horror of what they went through, losing everything in the fires, the emotional trauma of that, coupled with battling with their insurance companies to find out what their coverage was, only to have this guy run off with or squander their money and leave them scrambling — there’s almost nothing that could make them whole again.”
Joseph Matos ([email protected]), the director of communications for the Coalition Against Insurance Fraud, is a multi-award-winning creative and strategic executive who has successfully raised the bottom line for fortune 100 companies. He has also worked with some of the world’s largest and most prestigious ad agencies as their creative and strategic leader.
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