California Insurance Appraiser and Doctor Busted in Separate Fraud Schemes

California Auto Insurance Appraiser Gets 10 Years for Involvement in Staged Collision Ring

Erwin Raul Mejia of Van Nuys, Calif., was sentenced to 10 years in state prison following his conviction on 10 felony counts of insurance fraud for his role in a staged auto collision ring that bilked insurers out of more than $700,000. Mejia was also ordered to pay $699,784 in restitution to six auto insurers, including over $420,000 to Nationwide Mutual Insurance Company.

Mejia played an integral role in a staged auto collision ring involving hundreds of suspects. Since October 2017, 25 additional arrests were made in connection with this organized ring, which in total has resulted in $1.7 million in losses to insurers. The department’s investigation is ongoing and more arrests are likely to follow.

Mejia worked as a material damage appraiser for Nationwide where he inspected damaged vehicles, prepared repair estimates, and issued checks to claimants for their damaged cars. An investigation by the California Department of Insurance, which led to Mejia and additional suspects orchestrated an elaborate scheme to defraud insurers with paper collisions that never occurred or by intentionally damaging vehicles to submit fraudulent claims. Mejia often inflated the damages to the cars in his estimates and even wrote estimates for cars that were not actually damaged. He and a capper recruited people to insure vehicles and make fraudulent claims resulting in 70 fraudulent claims.

After leaving Nationwide, Mejia worked as a claims adjuster at Mejia Insurance in Nevada where he continued his scheme adjusting known fraudulent claims. MetLife issued settlement checks to the claimants that were redirected to a friend in Los Angeles who was cashing the checks. After leaving Mejia, MetLife went to Fred Mejia Insurance and then on to Loya Insurance. Additional victim insurers include State Farm, Wawanesa, and Mercury who were affected by the fraudulent claims generally as the second party involved, for example the claimant party.

The Los Angeles County District Attorney’s Office prosecuted this case.

California Doctor Indicted in $700,000 Insurance Fraud Scheme

Dr. Gary Royce Wisner, of Lodi, was set to be arriained yesterday at the San Joaquin County Superior Court on 11 felony counts of insurance fraud for bilking insurers out of more than $700,000 for allegedly providing unnecessary and excessive medical treatment for orthopedic patients.

“Dr. Wisner violated his Hippocratic Oath when he allegedly abused his patients and the workers’ compensation system to line his pockets with illegal profits,” said Insurance Commissioner Dave Jones.

The California Department of Insurance, the San Joaquin County District Attorney’s Office, the California Department of Justice Bureau of Medi-Cal Fraud and Elder Abuse, and the U.S. Department of Health & Human Services launched a multi-agency investigation, which revealed Dr. Wisner was providing unnecessary treatments, including exposing his patients to excessive X-rays—all for the purpose of committing insurance fraud. Dr. Wisner’s fraud resulted in a loss of over $700,000 to four insurers including State Compensation Insurance Fund, Zenith Insurance, Hartford and Tristar, the federal insurance system.

Health insurance fraud is a multi-billion dollar drain on California’s economy and results in higher insurance premiums for business and consumers. Over the last two years, the Department of Insurance has made arrests in health care fraud cases totaling more than $2 billion dollars.

On May 30, 2018, a San Joaquin County criminal grand jury indicted Dr. Wisner on 11 felony counts of insurance fraud. The San Joaquin County District Attorney’s Office is prosecuting this case.

Source: California Department of Insurance