Claims Fraud: Maryland, California and Florida

Maryland

A Maryland claims adjuster pleaded guilty to one count of theft after she was caught manipulating auto insurance claims so she could steal from her employers, Maryland Attorney General Anthony G. Brown’s office said Thursday.

Laurelle Monet Manley-Williams, 34, was hired as a claims adjuster for Agency Insurance Co. in July 2018. Only two months later, she started altering auto accident claims that were assigned to her by adding fraudulent passengers and issuing benefit checks to them, which she deposited into her own bank account, the Attorney General’s Office said.

To avoid detection, Manley-Williams later deleted the fictitious passengers from AIC’s records. She was able to steal $11,440.27 from the insurer before resigning in October 2018.

Manley-Williams began working for Allstate Property and Casualty Insurance Co. in November 2018. Almost immediately, she began adding fraudulent passengers to auto accident claims to steal a total of $23,964.95 from Allstate, prosecutors say.

Manley-Williams is scheduled to be sentenced on Jan. 30 by Judge Charles Carey Deeley Jr., the Attorney General’s Office said.

California

Two California women pleaded guilty this week for their alleged involvement in a scheme to defraud workers’ compensation insurers out of more than $100,000 through payments to a Bakersfield vocational school.

Sandra Parendez and Cynthia Ozaeta both worked for Instituto Hispano Americano, which provides vocational training to workers’ compensation claimants.

The California Department of Insurance announced in June 2021 the indictment of seven people associated with IHA and two local law firms on workers’ compensation insurance fraud charges. They are accused of misusing Supplemental Job Displacement Benefit Vouchers, which provide up to $6,000 to disabled injured workers for retraining.

According to the indictment, IHA paid law office employees up to $600 for each injured worker they referred. Employees of the school sent misleading documentation to insurance carriers saying the claimants were entitled to receive voucher money, even though they did not meet minimum requirements.

Parendez pleaded guilty on Thursday to a single charge of preparing a false insurance claim, KGET.com reporter. Prosecutors dropped dozens of other charges as part of a plea agreement.

Parendez must pay approximately $38,000 in restitution. A hearing is scheduled in March before Judge Michael G. Bush to determine if she is on track to complete the payments, KGET reported.

Ozaeta pleaded no contest to a misdemeanor accessory charge, KGET said.

Another woman who participated in the scheme, Anna Ayala-Reyes, is scheduled to be sentenced next year after pleading guilty in June to preparing a false insurance claim, KGET reported.

Sylvia Carrillo, Martin Cruz and Nelfido Cruz were also named in the indictment. They are scheduled for a hearing in January, KGET said.

Florida

Two Honduran nationals were sentenced to two years in federal prison on Nov. 3 after they were convicted on conspiracy and fraud charges in a check-cashing scheme.

Omar Wilkin Santos-Calix and Oscar Rene Santos-Santos, both who were in the United States illegally, created a shell company that purchased a workers’ compensation policy that covered only a few employees, according to the US Attorneys Office for the Middle District of Florida. They “rented” the proof-of-insurance certificate to work crews in Florida and other states so they could obtain subcontracts with construction companies that required proof they had purchased the mandatory workers’ compensation coverage, federal prosecutors say.

Santos-Calix and Santos-Santos cashed payroll checks for the workers’ wages and distributed the money to workers after deducting a 6% fee, according to the charges. The two took in more than $1 million from the scheme.

The scheme also cost the Internal Revenue Service $5,018,590 in payroll taxes, prosecutors said. The workers’ compensation policy that they purchased covered only $175,000 in payroll, with an annual premium of $21,000. Had the policy covered the actual payroll of approximately $19 million, the premium would have been about $2.5 million, the US Attorney’s Office said.

Santos-Calix was ordered to pay $3,245,151 in restitution to the IRS and a money judgment of $897,870. Santos-Santos was ordered to pay the IRS restitution of $1,773,429 and a money judgment of $490,634.