Ohio Insurance Department Reveals Top Fraud, Enforcement Cases

Lieutenant Governor and Insurance Director Mary Taylor announced Ohio’s top fraud and enforcement cases for 2014 investigated by the Ohio Department of Insurance.

During the calendar year, the department processed 7,173 allegations of agent misconduct and insurance fraud, initiated 1,709 investigations, identified 713 civil and criminal violations of Ohio insurance law, took administrative action against 460 agents and agencies, and referred 66 individuals for prosecution.

A total of $98,650 was assessed in fines.

Ohio Department of Insurance top statewide insurance fraud and enforcement cases for 2014:

Theft from Elderly: In September, Michelle Gavin, co-owner of the former Magetti Gavin Funeral Home in Dayton was sentenced in Montgomery County Common Pleas Court to four years in prison and five years of post-release supervision. Gavin previously pleaded guilty to 36 counts of theft from the elderly, grand theft, tampering with records and pre-need life insurance contract violations in a case totaling $300,000. She misappropriated funds from her clients and cashed in pre-need life insurance policies of living clients by claiming they had died.

Roofer Fraud: In August, Columbus roofer Terrance J. King, owner of Home Improvement Terrance King, was sentenced to 48 months in prison and ordered to pay $241,000 in restitution for defrauding homeowners, businesses and several public entities. King obtained money from insurance companies and his clients and often either failed to complete work as promised or falsely used inferior, second-hand products on contracted jobs. He also laundered money for personal use, filed fraudulent documents to receive subsidized housing assistance, and filed false federal income tax returns. King pleaded guilty to money laundering, false claims, and filing a false federal income tax return in November 2013.

Contractor Fraud: In October, Carol Richard, co-owner of All Seasons Contracting, was sentenced in the Lawrence County Court of Common Pleas to four years of community control — and three years in prison if she violates those terms — and ordered to pay $143,426.98 in restitution. She and her husband, Patrick Richard, entered into contracts with homeowners in the Ironton area and failed to provide the agreed upon services. Patrick Richard was sentenced to three years in prison in early January. All Seasons Contracting also submitted a false certificate of completion to an insurance company to support the payment of a homeowner’s insurance claim.

Title Agent Fraud: In March, former title insurance agent Charity Hensley, of Findlay, was sentenced in Hancock County Common Pleas Court. Hensley was ordered to serve 60 days in jail and five years of community control for misappropriating more than $73,000 in funds from her employer, Golden Key Title Agency.

Agent Fraud: In November, former Warren insurance agent Timothy J. Mulvey was sentenced in the Trumbull County Court of Common Pleas to five years of community control, 17 months of suspended prison time, and 60 days in the Warren Alternative Sentencing Program. Mulvey was also ordered to pay restitution for stealing $52,325.46 of his clients’ premium payments. Mulvey surrendered his agent and Mulvey Insurance Agency licenses in April 2013.

Agent Fraud: In June, former insurance agent Robert Horney, of West Mansfield, was sentenced in Logan County Common Pleas Court for grand theft, theft from the elderly, theft and insurance fraud. Horney sold property insurance policies to local residents but kept their premium payments, leaving them without insurance protection. He was ordered to pay more than $21,000 in restitution and serve 60 days in jail plus five years on community control. If Horney fails to abide by the community control sanctions, he could also face up to six and a half years in prison. Horney surrendered his agent license to the department in July 2013.

Auto Insurance Fraud: In April, resident John Deskins, of Cleveland, was ordered in Cuyahoga County Common Pleas Court to serve two years of probation for theft after he abandoned his car at a local repair facility and then filed an insurance claim – that totaled $9,000 – stating his vehicle had been stolen.

Fraudulent Dentist: In January, dentist Robert Balcar, of Holland, pleaded guilty in Lucas County Court of Common Pleas to attempted theft for billing private insurance companies for services not rendered. Balcar was ordered to serve one year of probation and pay restitution in the amount of $4,804.25.

Unlicensed Selling: In April, the Ohio Department of Insurance issued cease and desist orders to unlicensed insurance entity My Community Care LLC and its owner, Tannile Ortiz, for allegedly selling an unlawful product in the state of Ohio. The Hilliard, Ohio-based entity and Ortiz were not authorized to engage in the business of insurance or provide health insurance coverage in Ohio.

Agent License Revoked: In June, the insurance license of agent Carl Koneval, of North Olmstead, was revoked after he created a false surrender acknowledgement letter, forged the signature of an annuity contract holder and attempted to gain access to their online account without their knowledge or permission.

Source: Ohio Department of Insurance