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Utah Department of Insurance Fraud Division


Academic year: 2021

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Utah Department of


Fraud Division

Armand Glick Director


Insurance Fraud Division Staffing

11 – Law Enforcement Special Function


3 – Assistant Attorney Generals

2 – Legal Secretaries


Investigation Diversity

FY 2013 Total Referrals - 676

Agent Fraud 43 False Property Theft 82 Application Fraud 60 False Auto Theft 35 Healthcare 29 Staged Collisions 7 Exaggerated Injuries 31 Vehicle Arson 5 Doctor Shopping 6 Inflated Loss/Damages 15

Prior Injuries 11 False Damages 16 Slip and Fall 4 Property & Casualty -

Other 274 Other 55


FY 2013 Case Types Received

37 50 28 13 21 25 30 44 24 Agent Fraud Application Fraud Exaggerated Injuries False Claims False Loss

False Property Theft False Auto Theft

Staged Auto Accidents Medical Other


0 10 20 30 40 50 60 70 80 90 100 Misdemeanor B Misdemeanor A Felony 3 Felony 2

FY 2013 Charges Filed


FY 2013 Restitution Recovery

$100,000 $200,000 $300,000 $400,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 2010 2011 2012 2013

Out Side Victim Restitution

Investigative Cost Victim Restitution


Current Trends

Insurance Agent Fraud

False Auto Glass Claims – Sales Agent Fraud

Staged Auto Accidents

Past Posting Claims


Agent Fraud – Identity Theft

Using SSN and Birth Dates

of prior applicants to obtain

better credit scores for new


Increase new customers

Qualify for bonuses

Remove false person after


Pocketing Premiums

State vs. Rodgers

– Commercial Liability – $22,500 Restitution

– Pled Guilty (3) 2nd Felonies

and (2) 3rd Felonies

– Concurrent 1-15 years Prison


Pocketing Premiums

State vs. Kelling

– 50 years – family business – Commercial Liability

– Auto Coverage

– $86,000 Restitution – Still identifying victims


Agent Fraud – Fictitious Policies

• State vs. Kartchner  Created False Policies  Collected Undue Commissions  Farmer Bureau  $ 56,000


Agent Fraud - Forgery/Theft

• State vs. Mijares

• Created False Documents to Reduce Insured Premiums

• Altered Insured Cancellations to Obtain Refund – Kept by Mijares • Farmers Insurance


Cross Boarder Sales


– Selling Nevada Annuities to Utah Residents

– Listing PO Box as Resident Address

– Using Alternative ID Forms on Application


False Insurance Sales

State vs. Brady

$479,123 Total Loss

82 Victims

Brady sold home warranties to new home buyers during the closing process. Issued false certificates of insurance from a company that did not exist but was similar in name to a real company. No


Escrow Agent Case

State vs. Blake

– $800,000 loss

Blake kept closing money and did not pay off buyers old accounts. Placed money in personal account. Fabricated documents to provide buyer evidence loans had been paid.


Inflated Loss Collusion

State vs. McFarland

$6,000 Loss

McFarland inflated value of vehicle for a friend

involved in an accident. Payout larger than

vehicle loan value. Had two checks issued.

Owner gave McFarland some of the proceeds

from the fraud.


Claims Adjuster Fraud

State vs. Phillips

– Accident claims adjuster.

– Created false additional damage estimates for auto vs. animal accidents.

– Had payment checks made to her husband.

– Had payment checks sent to her home address. – $23,963 loss.


Staged Accident Prevention

Inspect Vehicles at

Policy Inception

Obtain Positive


Obtain Proof of



Soft Fraud vs. Hard Fraud

Where do you draw the line?

CPT Up Coding & Unbundling Excessive Treatment Duration Excessive Services / Unnecessary DOS Abuse of Diagnostics Fraudulent CTP Coding Falsifying Medical Records Billing for Services or DOS Not Performed or Ghost Patients

Spectrum of Fraud

Soft Hard


Billing Services Not Provided/Altering

Medical Records

State vs. Paxman

Victims: EMI, PEHP, Medicaid - $44,000


Billing Services Not Rendered/Forgery

State vs. Penegar PEHP


Falsely Listing Boyfriend as Spouse

• State vs. Strickland • Cambia, Altius,

Select Health


Faked Injuries/Finance Fraud

• State vs. Brown

• Emergency Room


• Paid with Bad Checks

• GEICO, Farmers, IMC


State vs. Guillen

State Farm Insurance $48,000


WC Death Benefits after Re-Marriage

• State vs. Perry

• Trans America Life • Total Loss: $60,000


State vs. Christensen

AAA Insurance $42,000


False Auto Glass Claims/Identity Theft

• State vs. Crose/Precise Auto Glass • 100’s of false claims • Impersonated the Insured • Farmers, American Family, Farm Bureau • Total Loss: $6,000


Staged Vehicle Burglaries/Thefts

• State vs. Sullivan

• Allstate, Homesite,

Safeware, Allianz, IDS,

Travel Insured, Tru Travel, Old Republic, Travel Guard, CSA, Tripmate, AMEX

• Attempted Theft - $107,000 • Obtained $68,000


Staged Vehicle Theft - Owner Give Up


Staged Auto Theft/Arson

State vs. Lopez

American Family Insurance $3,346


Uninsured Loss/Past Posting

• State vs. Smith

• Water Damage Loss • Reinstated Insurance

-then filed claim • Allstate


Staged Burglaries/Hurricane Damage

• State vs. Jhamb • Alta – New Jersey • Allstate, Selective

Insurance, Metlife, Veri Claim


False Auto Damage Circumstances

• State vs. Ngoyi & Warner • GEICO


Questions / Contact Information

Utah Insurance Department Fraud Division 230 South 500 East, Suite 170

Salt Lake City, Utah 84201 801-531-5380


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