On October 27, 2021, Victor Guerra-Ramirez was arrested in Luzerne County.  According to the criminal complaint, on February 1, 2021, the Attorney General’s office received information from Highmark Blue Cross Blue Shield, which alleged that “Cesar Rojas” fraudulently used a Social Security Number assigned to another person in order to enroll in his employer’s Highmark health care coverage. The complaint stated that while he worked for Nardone Brothers, “Rojas” was insured by the company’s Highmark plan from January 1, 2015 to February 1, 2015, and again beginning on January 1, 2018. “Rojas” allegedly terminated Highmark coverage on January 1, 2021. On February 1, 2021, Highmark learned that the Social Security Number that “Rojas” allegedly had used to enroll in the health care plan actually belonged to another individual. According to the complaint, “Rojas” admitted to law enforcement investigators that he entered the United States illegally in 2001, and made his way from Arizona to Pennsylvania. “Rojas” allegedly admitted that he had fraudulently used the name “Cesar Rojas” and the Social Security Number as his own. According to the complaint, “Rojas” told authorities that he had obtained the name and Social Security Number from someone in New York. The complaint stated that “Rojas” provided the investigator with Mexican identification and admitted that his birth name was actually Victor Guerra-Ramirez. The complaint further stated that due to Guerra-Ramirez’s alleged fraud, Nardone Brothers had paid more than $13,000 to Highmark for his health care coverage. Guerra-Ramirez was charged with one count of Identity Theft (F3), one count of Theft by Deception (F3), and one count of Insurance Fraud (F3).

October 27, 2021, Destinee Latimer was arrested in Allegheny County.  According to the criminal complaint, on February 24, 2021, Latimer obtained an automobile policy from Progressive for a 2015 Nissan Altima. On March 3, Latimer allegedly reported to the insurer that she had been driving the Altima on March 1, 2021, when it slid on ice and struck a pole at approximately 6:00 PM. The complaint stated that Latimer provided Progressive with photographs of the vehicle damage and requested a rental vehicle. According to the complaint, Progressive noted that the weather on the loss date did not include icy road conditions. The complaint further stated that the insurer discovered a February 14 social media post by Latimer’s boyfriend which allegedly stated that he had crashed the Altima into a pole. Photos of the damaged Nissan were included with the post. According to the complaint, investigators compared the posted photos with the pictures that Latimer had provided to Progressive and determined that the damages appeared to be the same. Latimer allegedly admitted that the loss occurred prior to the policy inception. The claim was denied. Latimer is charged with one count of Insurance Fraud (F3), one count of Criminal Attempt (F3), and one count of Theft by Deception (M2).

On October 27, 2021, Kenneth Heasley was arrested in Butler County.  According to the criminal complaint, on October 28, 2020, Heasley called in a collision claim to Progressive Insurance for damage to his Yamaha UTV. Heasley allegedly reported that he was trail riding on October 24 when at approximately 5:00 PM, his UTV struck a tree stump or a rock, and rolled over. During an investigation of the claim, Progressive discovered social media postings which allegedly included video of Heasley crashing the UTV at an organized race event on a closed track. According to the complaint, Heasley’s Progressive policy excluded from coverage any loss to the UTV which occurred as a result of an organized racing event or contest. The race track’s owner allegedly confirmed that Heasley’s UTV was involved in an accident during an organized racing event on October 24, 2020. The complaint further stated that Heasely admitted during a recorded interview that his UTV was damaged during the organized event. Progressive denied the claim. Heasley was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).

On October 26, 2021, Wade Campbell was arrested in Westmoreland County.  According to the criminal complaint, on March 5, 2021, at 3:45 PM, Campbell reinstated his cancelled Progressive Insurance automobile policy. During the reinstatement process, Campbell allegedly denied that his vehicle had been involved in any losses during the lapse in coverage. The complaint stated that on March 8, 2021, Campbell contacted Progressive and claimed that his vehicle collided with a neighbor’s vehicle as they were backing out of their respective driveways. Campbell allegedly advised Progressive that the accident occurred after he had reinstated his policy. However, according to the complaint, metadata retrieved from a photograph taken at the accident scene by the neighbor revealed that the loss actually occurred before Campbell reinstated his Progressive policy. Campbell allegedly admitted to our agent during a recorded interview that he had misrepresented the time of the loss in an attempt to have Progressive cover the damages. Progressive denied the claim.  Campbell was charged with one count of Insurance Fraud (F3), one count of Insurance Fraud (M1), and one count of Criminal Attempt/Theft by Deception (F3).

On October 20, 2021, Jennifer Cano and her brother Nestor Cano were arrested in Chester County.  According to the criminal complaint, on August 24, 2019 at 10:54 PM, Jennifer reported to Kemper Insurance that her Toyota was damaged while it was parked on a street on March 19, 2021. On April 1, Jennifer Cano allegedly told the insurer that she had parked her vehicle on the street at 2:00 AM, and approximately an hour later she discovered that the vehicle’s driver’s side rear tail light had been damaged. The complaint stated that during a subsequent recorded statement to the insurer, Jennifer Cano admitted that she had given her brother Nestor permission to use the vehicle. She allegedly told the insurer that her brother woke her up at approximately 4:00 AM on March 19, and told her that the parked vehicle had been damaged by a hit and run driver. According to the complaint, Jennifer Cano admitted that she allowed her brother to use her vehicle although his driver’s license was suspended. When Nestor Cano was contacted by a Kemper investigator, he allegedly admitted that the damage to his sister’s vehicle occurred while Nestor was using it on March 19. The complaint further stated that the insurer obtained security video of the accident from the gas station where the damage occurred. According to the complaint, Jennifer Cano renewed her vehicle policy on several occasions, but never informed the insurer that she routinely allowed her brother to operate her vehicle. Both Jennifer and Nestor were charged with one count of Insurance Fraud (F3) and one count of Criminal Conspiracy/Insurance Fraud (F3).

On October 18, 2021, Kerry Bonsell Sr. and Kerry Bonsell Jr. were arrested in Cambria County.  According to the criminal complaint, on February 15, 2021, Kerry Bonsell Jr. was added to Kerry Bonsell Sr.’s Progressive Insurance policy as a member of the household. At the same time, a 2016 Chevrolet Silverado was added to the policy. On February 17, 2021, Bonsell Jr. filed an insurance claim with Progressive in which he allegedly reported that he was involved in an accident while driving the Chevrolet Silverado the previous night. According to the complaint, Bonsell Sr. corroborated Bonsell Jr.’s claim. However, during the claim process, Progressive allegedly verified that a towing company towed the Silverado from the accident scene before the additions were made to Bonsell Sr.’s insurance policy. According to the complaint, an investigation revealed that Kerry Bonsell Sr.’s son Trevor had been operating the Silverado when the accident occurred. The complaint further stated that because Trevor had a suspended license, Kerry Bonsell Sr. and Kerry Bonsell Jr. agreed to tell the insurer that Bonsell Jr. had been driving the vehicle. Progressive denied the claim. The Bonsells were each charged with two counts of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).

On October 13, 2021, Gary Moore was arrested in Westmoreland County. According to the criminal complaint, on April 20, 2018, Moore obtained an Erie Insurance policy for a 2014 Dodge Avenger that he was financing.  During his application for coverage, Moore allegedly failed to disclose certain information which, according to Erie, would have prevented him from obtaining the policy. The complaint stated that on December 9, 2019, Moore filed a claim for damages to his vehicle. Erie estimated the damages at $890.19, minus the policy’s $500 deductible. The complaint stated that Erie Insurance sent Moore a check for $390.19, payable to Moore and to the repair facility, Oranges Auto. Erie also paid for a rental vehicle for Moore. On March 29, 2020, Moore allegedly filed another claim with Erie for different damages to the same vehicle.  Erie sent the same adjuster to inspect the damages, which were estimated at $1,460.15, minus a $250 deductible. According to the complaint, Moore received a check for $1,210.15, payable to Moore and to Oranges Auto.  Erie Insurance also paid for a rental vehicle.  The complaint further stated that during the process for the second claim, the Erie adjuster determined that the damage from the first claim had not been repaired.  An investigation allegedly revealed that the checks issued by Erie payable to Moore and Oranges Auto had been cashed, however, the purported Oranges Auto endorsements on the checks were not authentic. The complaint further stated that Oranges Auto denied ever making repairs to Moore’s vehicle. Moore was charged with one count of Insurance Fraud (M1), one count of Forgery (F3), one count of Identity Theft (M1), and one count of Theft by Deception (M1).

On October 11, 2021, Lomount Jorden Mills was arrested in Dauphin County.  According to the criminal complaint, on October 9, 2020, Mills filed a vehicle theft claim with his insurer, Nationwide Mutual. Mills allegedly reported that the theft occurred while his vehicle was parked outside of a store. The complaint stated that Mills told the insurer that he called his wife, then began walking to where she planned to pick him up. Mills allegedly claimed that while he was walking, he found his vehicle abandoned along a highway ramp about 2 or 3 miles from the theft site. According to the complaint, Mills claimed that the engine seized up when he tried to start the vehicle. Mills had the vehicle towed to Hoffman Ford in Harrisburg. According to the complaint, a service tech at Hoffman noted that the vehicle had significant oil leakage around the oil filter and that the engine had no oil. The complaint further stated that a Nationwide adjuster inspected the vehicle and noted that the entire rear of the vehicle was coated with a thick oil residue. An investigation revealed that Mills allegedly told Hoffman Ford that he had been driving the vehicle when he heard a “clicking” noise. Mills allegedly told Hoffman that he added oil to the vehicle, but it would not start. According to the complaint, the representative at Hoffman Ford advised that the engine problem was not covered by the vehicle warranty, because Mills had been operating the vehicle without engine oil. Nationwide denied the claim. Mills was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).

On October 6, 2021, Margaret Franks was arrested in Fayette County.  According to the criminal complaint, on December 19, 2020, at approximately 2:30 PM, Franks was driving her 2017 Hyundai Accent when it struck another vehicle.  After the accident occurred, Franks allegedly checked her Progressive Insurance Company automobile insurance policy online and verified that the policy had lapsed on November 9, 2020.  On the same day at approximately 2:58 PM, Franks allegedly reinstated her policy online. At approximately 3:34 PM, Franks filed an insurance claim online with Progressive in which she allegedly reported that her vehicle was involved in an accident at approximately 3:30 PM.  According to the complaint, Progressive took a statement from the other involved driver, who maintained that the accident had occurred on December 19, 2020 between the hours of 2:30 PM and 2:45 PM. Progressive allegedly determined that the crash occurred prior to the inception of Franks’ policy and denied coverage. Franks is charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3).

On October 6, 2021, Mark & Donna Lisovich were arrested in Fayette County.  According to the criminal complaint, the married couple obtained an Erie Insurance Home Protector policy which took effect on May 5, 2020.  In July 2020, the couple allegedly purchased an above ground pool and installed it themselves.  The complaint stated that on August 10, 2020, the Lisovichs filed a claim with Erie Insurance seeking coverage for damage to the pool supports which buckled due to heavy rain. Erie inspected the pool and discussed coverage concerns with the Lisovichs, who then allegedly withdrew their claim. According to the complaint, on November 19, 2020, the Lisovichs obtained a tenant policy from Nationwide Insurance for the same residence. On March 8, the couple filed a claim with Nationwide Insurance in which they allegedly claimed that on March 6, they discovered that their pool had been damaged by freezing weather during the winter. According to the complaint, the Lisovichs denied having problems with the pool or previously filing an insurance claim for the pool. Nationwide investigated the claim and learned that the couple previously filed the claim with Erie Insurance for damage to the pool. During a subsequent interview, the Lisovichs allegedly admitted that they made false statements to Nationwide. Both Mark and Donna Lisovich were charged with two counts of Insurance Fraud (F3) and one count of Criminal Conspiracy/Theft by Deception (F3).

On October 4, 2021, Holly Rush was arrested in York County.  According to the criminal complaint, on May 13, 2021, at 9:00 AM, Rush purchased a Progressive Insurance automobile policy which included liability and comprehensive coverage.  On May 13, 2021, at 4:00 PM, Rush filed an automobile insurance claim in which she allegedly told Progressive that her vehicle was vandalized at 1:00 AM that morning. The complaint stated that Rush was subsequently informed by Progressive that her claim would not be covered because her policy was not in effect at the time of the loss. On May 15 at 2:45 PM, Rush filed another claim, in which she allegedly reported to Progressive that her vehicle was vandalized at 12:45 AM on May 14. However, the complaint further stated that the insurer denied the claim after determining that Rush had reported the same damage, which occurred prior to the policy inception. Rush was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (M1), and one count of Criminal Use of Communication Facility (F3).

On October 26, 2021, Sameerah Graham was sentenced in Lycoming County. In August, Graham entered open pleas to one count of Insurance Fraud (F3), one count of Criminal Attempt/Theft by Deception (F3), and one count of Insurance Fraud (M1).   Graham obtained a Progressive Insurance automobile policy on May 11, several months after her previous vehicle coverage was cancelled. On May 14, Graham called Progressive and added rental coverage to her new policy, effective May 19. During the call, Graham asked the representative if the rental coverage would apply if her vehicle struck a deer. On May 20, Graham called Progressive and reported that the front passenger side of her vehicle had been damaged by a deer strike that occurred as Graham was driving home from an overnight work shift. During the claim investigation, the insurer asked Graham to provide additional information, including copies of her recent work timesheets. Graham provided timesheets which indicated that she had worked 40 hours per week as a home health care aide on weeknights from 11 PM to 7 AM. When investigators contacted Graham’s employer to confirm the information, Graham’s supervisor advised that Graham had not worked on the May 20 date of loss and that she only worked on alternate weekends. The supervisor also maintained that the timesheets provided to Progressive were not those utilized by the home health company. Progressive denied payment of Graham’s claim.   Graham was ordered to serve an aggregate total of three years of supervised probation. She was further ordered to pay costs and to perform 75 hours of community service.

On October 21, 2021, Tiendy Petit-Homme was sentenced in Montgomery County after entering into a negotiated plea to one count of Attempt/Theft by Deception (M1). Petit-Homme was operating his uninsured vehicle on February 25, 2018, at approximately 2:13 PM, when the vehicle was involved in an accident. Petit-Homme spoke very briefly with the other driver and then quickly left the scene prior to police arrival. At approximately 3:54 PM that day, Petit-Homme went online and obtained an auto policy from Progressive Insurance. At approximately 4:45 PM, Petit-Homme returned to the scene of the accident and provided his Progressive policy information to a police officer. When the officer noted that the policy became effective that day, Petit-Homme told the officer that his policy went into effect at midnight and therefore was in place when the accident occurred. The officer later contacted Progressive and was advised that the policy actually became effective at 3:54 PM. Petit-Homme accessed Progressive’s mobile app on February 27, 2018 and filed a claim for the accident. On February 28, 2018, during a telephone interview with a Progressive representative, Petit-Homme said that he had purchased the policy before the accident. A subsequent investigation revealed that the accident occurred prior to Petit-Homme’s policy inception. Progressive denied the claim. Petit-Homme was sentenced to serve two years of probation and ordered to pay a civil penalty of $2,000.

On October 21, 2021, Matthew Urmersbach was sentenced in Montgomery County after entering a negotiated plea to Insurance Fraud (F3). On March 9, 2019, Urmersbach’s Progressive Insurance auto policy was cancelled. Urmersbach called Progressive at 5:35 PM on March 12, 2019, and reinstated his prior coverage. In doing so, he told the insurer that his vehicle had not been involved in any losses between the date of his policy cancellation and the date of its reinstatement. On the following day, Urmersbach called Progressive and reported that he had been involved in an accident on March 12 at 7:50 PM.  During a subsequent conversation with the insurer, Urmersbach claimed that the accident occurred at 5:49 PM. An investigation revealed that the crash actually occurred before Urmersbach’s coverage was reinstated. Progressive denied Urmersbach’s claim. Urmersbach was ordered to serve 12 months of reporting probation and ordered to perform 30 hours of community service.

On October 14, 2021, Thomas William Simpkins was sentenced in Green County after entering into a negotiated plea to one count of Criminal Attempt/Theft by Deception (M1).  On March 6, 2020, Simpkins purchased full coverage for his Chevy Cruze from Progressive Insurance. On April 10, 2020, Simpkins filed a claim with the insurer and reported that the front and rear passenger doors of the Cruze were damaged in a hit and run accident. Simpkins provided the insurer with photos of the damage. The photo metadata confirmed that the pictures were taken on April 13, 2020. Progressive paid Simpkins $1,935.88 on the claim.  The policy was cancelled for non-payment of premium on July 1, 2020. On August 14, Simpkins purchased a new policy from Progressive. He subsequently filed a claim and reported that the passenger side of his vehicle had been damaged in another hit and run accident. Investigators compared photos from both claims and determined that the damage to Simpkins’ vehicle was the same. Progressive denied the August claim.  Simpkins was ordered to serve 24 months of probation, perform 75 hours of community service and pay all costs.

On October 13, 2021, Khadeem Cooper was sentenced in Bucks County after entering an open plea to one count of Insurance Fraud (F3) and one count of Criminal Attempt/Theft by Deception (F3). On March 29, 2019, Cooper attempted to purchase a 2008 Nissan Maxima priced at $10,455.00 from a local Mitsubishi dealership. Dealership affiliate Pennsylvania Auto Credit provided financing for the Nissan. While Cooper was completing the necessary paperwork for the purchase, he filled out a PennDOT MV-4ST form to register the vehicle and obtain temporary plates for the 2008 Nissan Maxima. Cooper then presented a forged State Farm financial responsibility insurance card to a dealership employee who was also an authorized PennDOT agent. The card purported to show that Cooper had a Pennsylvania insurance policy through State Farm which covered a Buick sedan. When the dealership contacted the insurance agency listed on the card to verify Cooper’s coverage, the agency advised that it was only licensed to write policies in Delaware. Upon reviewing the information on the insurance card, the agency informed the dealership that the information was fraudulent. A subsequent investigation revealed that Cooper had purchased the phony insurance card through social media for $350.00, and had never owned the “insured” Buick sedan.  Cooper was ordered to serve 11 ½ - 23 months of county incarceration, followed by two years of reporting probation.

On October 12, 2021, Denise Anastasio was sentenced in Berks County after entering a negotiated plea to one count of Criminal Attempt/Theft by Deception (F3). Anastasio filed a claim with Progressive Insurance on September 17, 2020, in which she stated that her 2007 Scion was vandalized after it became disabled in the parking lot of a Redner’s convenience store. Anastasio claimed that she drove the car to Redner’s to put air in the tires on September 12, but when she returned to the car, the key broke off in the ignition. Anastasio claimed that she locked the car and left it at Redner’s. She further claimed that she was subsequently contacted by a Redner’s employee and advised to move her car. Anastasio told Progressive that she arranged to have the car towed, but when she returned to the store to meet the tow truck on September 14, Anastasio found that her car’s steering column and ignition had been damaged. Anastasio provided two digital photos of the damage to Progressive. The photo metadata revealed that the pictures were taken on September 10, 2020, two days before Anastasio’s car purportedly became disabled at Redner’s. Progressive contacted Spring Township police and confirmed that Anastasio filed a vehicle vandalism report on September 1, 2020. According to police, Anastasio reported that she had loaned the car to someone who did not return it. Police provided Progressive with time and date-coded photos that were taken from the store’s security video footage. The shots revealed that the Scion was parked at the store location from August 14 to August 17, 2020, a month earlier than Anastasio had claimed. Progressive determined that the car was not vandalized, but that the damage stemmed from mechanical failure not covered by the policy. The claim was denied. Anastasio admitted to investigators that the car was not in her possession when it became disabled at Redner’s. Anastasio was ordered to serve two years of supervised probation.

On October 12, 2021, Raymond Foster and John Stafford, Jr. were sentenced in Fayette County after entering negotiated pleas. Foster pled to one count of Insurance Fraud (F3) and Stafford pled to one count of Criminal Attempt/Theft by Deception (M1). On November 14, 2018, Foster filed a claim with Progressive Insurance indicating that his vehicle was damaged earlier that morning after he had swerved to avoid striking a deer. During the initial phone call with Progressive, Foster indicated that he had been driving the vehicle at the time of the accident and that his cousin, Stafford, was a passenger.  During the claims process it was learned that Foster was an excluded driver on his own policy, because his license was suspended. When Progressive mentioned this to him, Foster stated that his cousin, Stafford, was driving at the time of the accident. On November 19, 2018, Progressive conducted a recorded interview with Stafford. Stafford allegedly told Progressive that he, not Foster, was driving at the time of the accident. A subsequent interview of the responding police officer confirmed that Foster was in fact the driver of the vehicle.  Progressive denied the $12,524.94 claim. Foster was ordered to serve 9 to 24 months of house arrest and to pay all costs. Stafford was ordered to serve two years of probation and to pay all costs.

On October 6, 201, Xhasa Green was sentenced in Allegheny County after entering a negotiated plea to one count of Insurance Fraud (F3).  At 10:23 PM on December 13, 2020, Green telephoned Pittsburgh police and reported that her 2016 Nissan Altima was stolen minutes earlier. Police responded and wrote a report detailing the date and time.  On December 14th at 12:27 AM, Green purchased a Progressive Insurance policy for the vehicle.  At 11:00 AM that morning, Green filed a vehicle theft claim with Progressive. She told the insurer that the Nissan was stolen sometime between 1:00 AM and 2:00 AM on December 14. On February 25, 2021, a Progressive representative spoke with Pittsburgh police and learned that Green’s 2016 Nissan Altima was stolen and damaged in a crash before Green obtained insurance.  On March 17, 2021, Green admitted to investigators that she purchased the policy and filed the claim after the vehicle was stolen and damaged, because she wanted Progressive to cover the loss.  Green was ordered to serve two years of probation, the first four months of which she is to serve under house arrest. Green also was ordered to pay all court costs.

Pennsylvania Bulletin Notice 2016-04 (issued April 30, 2016) reminded insurers of their obligations to report suspected arson or insurance fraud to law enforcement agencies within the Commonwealth.  The bulletin also announced a decision by the Pennsylvania Department of Insurance to allow licensees to satisfy their reporting obligation when they electronically submit reports of suspected fraud to the National Insurance Crime Bureau (NICB).

 

On July 6, 2017, Pennsylvania began participating in this online service which enables member companies to electronically forward reports of suspected fraud to the Pennsylvania Office of Attorney General’s Insurance Fraud Section or other appropriate law enforcement agencies at the same time the companies report suspicious claims to the NICB. NOTE: The NICB is not a law enforcement agency. Therefore, a licensee cannot satisfy the fraud reporting requirement by submitting a non-electronic (paper) referral only to the NICB.

 

Important: When utilizing electronic filing through NICB, users should take careful note of the provided instructions regarding the “Party” to a claim.  Information entered about a Party will only be transmitted to law enforcement if users select one of two options: “This Party was subject to an SIU investigation” or “This Party was subject to an enforcement action.”  Some users have missed this notation about individual Party data and consequently have submitted incomplete information to law enforcement.