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Woman Sentenced for Defrauding Insurer of More Than $23,000 in Medical Claim Proceeds
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 On January 11, 2024, Jessica Davis was sentenced in Berks County after entering a negotiated plea to one count of Insurance Fraud (F3), one count of Theft by Deception (F3), one count of Receiving Stolen Property (F3), and one count of Forgery (M1). Davis was an employee of R&B Insurance Services and had access to Allstate Benefits supplemental insurance coverages for Accident, Critical Illness, and Group Indemnity Medical. On February 2, 2018, with an effective date of March 1, 2018, Davis prepared and submitted an Allstate Benefits enrollment form for Accident and Critical Illness coverage, which provided coverage for herself, her two children, and Jessica’s sister. Davis later prepared and submitted an Allstate Benefits enrollment form for Group Indemnity Medical coverage. Between September 26, 2018, and September 19, 2022, Davis submitted thirty-seven claims to Allstate for services that Davis, her children, and Davis’s sister purportedly received. Davis received approximately $23,330.00 in claim proceeds from Allstate, which she deposited into four separate bank accounts in her name. A review of the medical documentation that Allstate received from Davis in support of the claims revealed a pattern of alterations and inconsistent information. Investigators determined that none of the claimed services were rendered. Davis was sentenced to serve 7 years of probation. She was ordered to complete 50 hours of community service, pay $23,330.00 in restitution to Allstate, pay all court costs, and surrender her insurance license. |
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 On January 31, 2024, Alison Graeffe was arrested in Montgomery County. According to the criminal complaint, at 9:38 AM on November 18, 2022, Graeffe went online and obtained an automobile policy from Progressive Insurance Company for her 2019 Nissan Rogue Sport. During the application process, Graeffe allegedly stated that the vehicle had not been involved in any recent accidents. Later that same day, Graeffe allegedly called Progressive and reported that she had been driving her Nissan that morning when it struck a concrete barrier on the PA Turnpike. Graeffe allegedly told the insurer that the crash occurred between 11:30 AM and 12:00 PM. According to the complaint, the Nissan sustained damage to the passenger side and front wheel well, which rendered the vehicle inoperable. The complaint stated that the Pennsylvania State Police responded to the crash scene, and Rob’s Automotive Center sent a tow truck to remove the damaged Nissan. On November 19, 2022, a Progressive Claims Representative conducted a recorded interview with Graeffe, who allegedly maintained that the accident occurred around 11:00 AM on November 18, which was after her policy was in effect. The complaint stated that on November 20, Graeffe uploaded to Progressive’s online portal a copy of the PSP Commonwealth of Pennsylvania Driver Notice and Exchange Report, which purportedly confirmed that the accident occurred on November 18, 2022, at 11:00 AM. However, according to the complaint, a Progressive claims representative noticed that the time of loss appearing on the document appeared to have been altered. When investigators contacted the PSP to verify the time of Graeffe’s accident, they allegedly learned that the crash occurred at 9:00 AM on November 18, 2022. According to the complaint, Progressive subsequently obtained a copy of the PSP report, which confirmed the time of the accident as 9:00 AM on November 18. On November 30, 2022, investigators conducted a recorded interview of Graeffe. During the interview, investigators allegedly advised Graeffe that Progressive had secured a copy of the report from PSP, which showed that the crash occurred at 9:00 AM, prior to the inception of Graeffe’s coverage. According to the complaint, Graeffe was unable to explain why the time of loss documented in the PSP report was different from the time she had previously provided to Progressive. The insurer denied the claim. Graeffe was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), one count of Criminal Use of Communication Facility (F3), one count of Forgery (F3), and one count of Insurance Fraud (M1).
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 On January 29, 2024, Rosaura Colon was arrested in Montgomery County. According to the criminal complaint, on April 8, 2021, at approximately 6:18 PM, Colon purchased a policy from Progressive Insurance Company, which covered her 2017 Dodge Ram 1500 and several other vehicles. The insurer canceled the policy on March 18, 2022, after Colon allegedly failed to pay the premium. On March 19, 2022, Colon allegedly purchased a vehicle policy from Liberty Mutual Insurance. The complaint stated that on February 8, 2023, Colon filed a claim with Liberty Mutual for damage to her Dodge Ram 1500. Liberty Mutual denied the claim and canceled Colon’s policy on February 9, 2023, after determining that Colon allegedly made material misrepresentations to the insurer. According to the complaint, Colon then purchased a new Progressive Insurance policy, which went into effect at 11:01 AM on February 9. The complaint stated that on February 28, 2023, at 11:16 AM, Colon called Progressive and filed a claim for damage to her Dodge Ram pickup truck. Colon allegedly claimed that moments before she called, her parked truck was struck and damaged by an unknown vehicle. According to the complaint, Colon submitted photos of her truck to Progressive. Investigators reviewed the metadata from those photographs and allegedly found that the photos were taken at 9:23 AM on February 9, 2023, approximately two hours before the inception of Colon’s Progressive policy. The complaint further stated that investigators compared the photos with pictures that Colon allegedly submitted to Liberty Mutual and found the damage to be the same in both sets of photos. During several recorded interviews with investigators, Colon allegedly denied that her truck had any damage prior to the February 28, 2023, accident. The complaint stated that investigators reviewed the Philadelphia Police report of the hit-and-run accident involving Colon’s vehicle and noted that the report documented that the incident occurred at 5:00 PM on February 8, 2023, the day before Colon purchased coverage from Progressive. Progressive denied the claim. Colon was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), and one count of Criminal Use of a Communication Facility (F3), and one count of Insurance Fraud (M1).
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 On January 25, 2024, Jason Riley was arrested in Crawford County. According to the criminal complaint, on December 28, 2022, Riley purchased a new United Services Automobile Association (USAA) renter’s policy, which took effect on December 29, 2022. On December 29 at 12:16 PM, Riley allegedly went online and filed a claim with USAA in which he reported that a pipe had burst in his apartment and caused approximately $4,574.00 in damage to his personal items. During a January 3, 2023, recorded telephone conversation with investigators, Riley allegedly stated that he discovered the damage on December 29, 2022, when he returned home from visiting his family for Christmas. On January 5, Riley allegedly emailed USAA a list of damaged personal items, as well as photos and video footage in support of his claim. According to the complaint, the video metadata revealed that the footage was taken on December 27, 2022, prior to the effective date of Riley’s coverage. The complaint stated that investigators spoke with the property manager of Riley’s apartment complex, who advised that Riley contacted her at approximately 12:45 PM on December 27, 2022, and reported that the radiator in his unit had burst. USAA denied the claim. Riley was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F3).
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 On January 24, 2024, Birendra Jha was arrested in Allegheny County. According to the criminal complaint, on May 4, 2020, Jha, the owner of Hansika Enterprises, obtained a Liberty Mutual Insurance business owner’s policy. On February 15, 2021, the associate manager of Hansika Enterprises allegedly reported to the Dormont Borough Police that when he arrived at a company-owned Boost Mobile retail store that day, he found the store’s door unlocked and determined that a theft had occurred. According to the complaint, the associate manager told police that once the company’s owner, Jha, was notified and an inventory was completed at the store, a list of missing items would be provided to the police. However, police officers allegedly found no signs of forced entry at the Boost Mobile store and found no indication that the business had been ransacked. On February 16, 2021, the associate manager allegedly provided police with an itemized list of the stolen items, with a total value of $23,116.54. According to the complaint, Jha contacted Liberty Mutual Insurance on February 16 and reported the February 15 loss. On February 24, Jha allegedly emailed Liberty Mutual a notarized statement and list of the purportedly stolen items, valued at a total of $23,301.85. However, according to the complaint, investigators reviewed company business records and determined that the dozens of cell phones and related electronic items appearing on the list had not been stolen but were sold to customers and activated for use. Investigators conducted multiple interviews with Jha and his associate manager. At times during the interviews, Jha allegedly contradicted himself, became upset, and stated that he “had the right to file a claim.” The complaint stated that Jha eventually disclosed to investigators that the Boost Mobile store was struggling financially at the time of the incident. Liberty Mutual denied the claim. Jha was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F).
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 On January 24, 2024, Carol Haslam was arrested in Philadelphia County. According to the criminal complaint, Haslam insured her 2016 Jeep Renegade under a Progressive Insurance Company policy until the policy was canceled for nonpayment on May 30, 2023. The complaint further stated that at 6:00 PM on June 6, 2023, Haslam’s teenage daughter was driving the uninsured Jeep Renegade in Philadelphia, when it was involved in a two-vehicle accident. The daughter allegedly told investigators that she called her mother right away and that Haslam arrived at the accident scene a few minutes later. According to the complaint, while she was at the accident scene, Haslam went online and reinstated her lapsed Progressive coverage. During the reinstatement process, Haslam allegedly reported that the Jeep Renegade had not sustained any damage during the period of no coverage. According to the complaint, the policy was reinstated at 6:22 PM. On June 7, 2023, at 5:02 PM, Haslam allegedly called Progressive and reported the accident involving her Jeep. According to the complaint, she told the insurer that the crash had occurred at 7:00 PM on June 6. Progressive subsequently interviewed Haslam’s daughter and the driver of the other involved vehicle. Both drivers allegedly told the insurer that the accident happened at 6:00 PM on June 6, which was prior to the reinstatement of Haslam’s coverage. The complaint stated that during a subsequent interview by Progressive, Haslam admitted that she reinstated her lapsed policy after the accident occurred. Progressive denied the claim. Haslam was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), one count of Criminal Use of a Communication Facility (F3), and one count of Insurance Fraud (M1).
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 On January 23, 2024, Julia Snyder was arrested in Beaver County. According to the criminal complaint, Snyder obtained a Glacier Insurance automobile policy for her 2011 Subaru Legacy at 5:03 PM on December 8, 2023. The complaint further stated that on December 11, 2023, Snyder went online and submitted a claim to Glacier for an accident involving her Subaru. Snyder allegedly claimed that the Subaru was involved in a two-vehicle accident, which occurred at approximately 5:30 PM on December 8, 2023. According to the complaint, investigators contacted the driver of the other involved vehicle, as well as police and the tow company that responded to the crash scene and confirmed that the accident actually occurred at 3:12 PM on December 8, 2023. Snyder allegedly admitted to investigators that she gave false information about the time of the accident to Glacier Insurance, in an attempt to get coverage for her damaged vehicle. Glacier denied the claim. Snyder was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F3).
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 On January 23, 2024, Lejaney Blue was arrested in Montgomery County. According to the criminal complaint, on January 26, 2022, Blue went online and purchased coverage for her 2018 BMW 320 from Progressive Insurance Company. During the application process, Blue allegedly indicated that she lived at an address in Philadelphia. According to the complaint, Blue’s BMW was stolen while she allegedly was involved in an altercation as she was leaving a restaurant in New Jersey on October 15, 2022. The complaint further stated that the BMW was involved in an accident in New Jersey that same evening. According to the complaint, the BMW was recovered on October 17, 2022, and Blue submitted a claim to Progressive for the damage to her car. Progressive determined that the BMW had sustained approximately $24,106.00 in damages. The complaint stated that on October 19, Progressive investigators discovered that Blue had been living in New Jersey since November 2018. Progressive took a recorded statement from Blue, during which she allegedly insisted that she has been living at the Philadelphia address reflected on her application and that her BMW is garaged there. The complaint stated that the insurer then asked Blue to provide documentation of her place of residence. Blue allegedly provided a copy of her purported 2022 - 2023 lease for the Philadelphia residence. According to the complaint, the lease listed TCS Management as the leasing agent, but a TCS representative advised investigators that the company stopped managing that property in 2021. The complaint further stated that the TSC President reviewed the copy of the lease that Progressive received from Blue and advised that the first page of the document appeared to have been altered. The company official also allegedly pointed out that Blue’s signature and other information on the document were dated “2017.” On October 21, 2022, investigators contacted the current manager of the Philadelphia property, who allegedly confirmed that Blue had not been a tenant at that address during the two years that the company managed the property, including the date on which Blue purchased the Progressive policy. On November 7, 2022, Blue’s claim was denied by Progressive. Blue was charged with one count of Insurance Fraud (F3), one count of Theft by Deception (F3), one count of Criminal Attempt / Theft by Deception (F3), one count of Criminal Use of Communication Facility (F3), one count of Forgery (F3), and one count of Insurance Fraud (M1).
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 On January 16, 2024, Richard Cunningham was arrested in Franklin County. According to the criminal complaint, Cunningham had a liability policy from Progressive Insurance Company, which insured his 2005 Scion TC from December 17, 2022, to June 17, 2023. On June 15, 2023, at 1:36 PM, Cunningham allegedly added comprehensive and collision coverage to the policy, effective June 17, 2023, at 12:01 AM. The complaint stated that on June 19, 2023, Cunningham contacted Progressive and stated that his Scion was involved in an accident on June 16, when he swerved to avoid an object on the road. However, during a conversation with a Progressive claims adjuster, Cunningham allegedly stated that the accident had occurred between 10:30 PM and 11:00 PM on June 17, 2023, rather than on June 16. According to the complaint, Cunningham also told the adjuster that the accident had occurred in Maryland and that the Scion was towed from the scene. The complaint stated that investigators obtained copies of the tow company invoice and the Maryland State Police crash report, both of which revealed that the accident occurred on June 14, 2023, before Cunningham added comprehensive and collision coverage to his policy. Cunningham allegedly admitted to investigators that he had misrepresented the date of the accident in an attempt to have Progressive cover the damages. Progressive denied the claim. Cunningham was charged with one count of Insurance Fraud (F3) and one count of Criminal Attempt / Theft by Deception (F3).
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 On January 9, 2024, Jacobe Sandcroft was arrested in Montgomery County. According to the criminal complaint, Sandcroft’s Progressive Insurance Company vehicle policy expired on July 22, 2022. On November 28, 2022, Sandcroft allegedly purchased a new Progressive policy, which became effective on November 28, 2022, at 5:08 PM. According to the complaint, when Sandcroft obtained the new policy from Progressive, he affirmed that his vehicle had not sustained any damage while it was uninsured. The complaint stated that on November 29, 2022, at 3:06 PM, Sandcroft reported to Progressive that on November 27, 2022, his vehicle had been involved in an accident while he was driving in Philadelphia between 6:30 PM and 7:00 PM. The complaint further stated that on November 30, Sandcroft spoke with a Progressive representative who explained that the November 27, 2022, accident would not be covered by the previous policy that expired in July, nor would it be covered by Sandcroft’s current policy, which was not in effect on the date of loss. On December 1, 2022, at 9:29 PM, Sandcroft allegedly contacted Progressive and claimed that his car was involved in an accident on November 29, 2022, after his policy took effect. According to the complaint, Sandcroft explained that he made a typographical error when he previously reported the accident date as November 27, 2022. The complaint further stated that Sandcroft allegedly left a voicemail for Progressive, asking the insurer to reconsider his claim, since the loss had occurred after his current policy was in place. However, according to the complaint, an investigation revealed that Sandcroft’s car was towed from the accident scene on November 27, 2022, at 8:50 PM, the day before his current policy commenced. During a recorded telephone conversation with a Progressive investigator, Sandcroft allegedly maintained that the accident occurred on November 29, 2022. The complaint further stated that Sandcroft then changed his story and said that the crash occurred on November 28, 2022, at 10:00 PM, which was several hours after his coverage was in place. Eventually, Sandcroft allegedly admitted to the investigator that the accident occurred on November 27, 2022, before he obtained his current coverage. Sandcroft was charged with one count of Insurance Fraud (F3), one count of Criminal Attempt / Theft by Deception (F3), one count of Criminal Use of a Communication Facility (F3), and one count of Insurance Fraud (M1).
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 On January 30, 2024, Thomas Halye was sentenced in Schuylkill County after entering a negotiated plea to one count of Criminal Attempt / Theft by Deception (M1). On June 30, 2021, at 3:04 PM, Halye obtained an auto policy from Permanent General Assurance Corporation of Ohio (The General) for his 1995 Jeep Grand Cherokee Laredo. On July 27, 2021, at 10:00 PM, Halye contacted The General and reported that he had been driving the Laredo on July 16, 2021, when he fell asleep at the wheel and the Jeep struck a building at approximately 1:00 AM. Halye told the insurer that the accident damaged the Jeep’s front end, as well as the front vestibule of the Mountaineer Hose Company in Minersville. Investigators obtained a copy of the police incident report, which revealed that the accident occurred at approximately 7:00 AM on June 29, 2021, which was prior to the inception of Halye’s policy. Halye received a sentence of time served to 23 months of incarceration in Schuylkill County Prison. He was ordered to pay a $250.00 fine and all court costs.
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 On January 30, 2024, Andrew Anderson was sentenced in Fulton County after entering an open plea to one count of Insurance Fraud (F3). On April 25, 2023, Anderson reported to Sentry Insurance that his 2015 Chrysler 200S struck a deer on April 19. Anderson told the insurer that the impact damaged the right front area of his vehicle and caused the Chrysler’s airbag to deploy. Anderson claimed that the vehicle had no prior damage. Sentry Insurance conducted an investigation and discovered that Anderson made a similar claim in December 2021. Investigators compared photographs of the Chrysler from both claim files and found the damage to be nearly identical. When Sentry Insurance contacted Anderson about the findings, Anderson claimed that the vehicle was repaired following the December 2021 claim. Anderson became uncooperative when Sentry asked for receipts and other documentation of the purported repairs. Ultimately, Sentry denied the April 2023 claim. During an interview with law enforcement investigators, Anderson admitted that he never repaired the earlier damage and that he made misrepresentations to Sentry in support of his April 2023 claim. Anderson was sentenced to a term of 3 to 24 months of incarceration. He was ordered to complete 50 hours of community service and to pay a $250.00 fine and court costs.
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 On January 25, 2024, Angela Echevarria was sentenced in Philadelphia County after entering a negotiated plea to one count of Insurance Fraud (F3) and one count of Forgery (F3). On February 15, 2022, Echevarria used the Progressive Insurance Company website to purchase a personal auto policy for her 2014 Honda Accord. The coverage became effective at approximately 10:30 PM that same day. During the online process, Echevarria provided the insurer with a Pennsylvania residential address, driver’s license, and vehicle registration for the 2014 Honda Accord. On February 16, 2022, at 6:09 AM, Echevarria submitted an online collision claim to Progressive and reported that her Honda had been involved in an accident in New York City at approximately 2:45 AM. Echevarria provided the insurer with a photo that purportedly was taken immediately after the accident occurred. However, the metadata revealed that the photo of the damaged vehicle had been taken on February 15, 2022, at 1:27 PM. Further, investigators established that Echevarria resided in New York City and that she never lived at the Philadelphia address indicated on her Progressive application and on the paperwork that Echevarria submitted to PennDOT. Echevarria was ordered to serve two years of probation and to pay a $1,000.00 civil penalty to the PA Insurance Fraud Prevention Authority.
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 On January 17, 2024, Raymond Mills, Jr. was sentenced in Montgomery County after entering a negotiated plea to one count of Insurance Fraud (F3). Progressive Insurance Company canceled the automobile policy covering Mills’ 2017 Jeep Compass after he failed to pay the premium. On March 3, 2022, at 10:46 AM, Mills called Progressive and purchased a new policy for his Jeep Compass. At approximately 3:36 PM, Mills again called Progressive and filed a claim for hit-and-run damage to his Jeep. During several recorded statements to Progressive representatives, Mills maintained that the damage had occurred on March 3, between 2:30 PM and 3:30 PM. However, during one of the recorded conversations, Mills stated that the accident had occurred between 9:00 AM and 11:00 AM. An investigation revealed that Mills called Progressive from the accident scene to get coverage for his Jeep. Progressive recorded the call, during which a State Trooper could be heard telling Mills to move his Jeep to a safer location. The Trooper subsequently asked Mills if he had been using his phone to obtain insurance. Mills admitted that he had. Investigators obtained a copy of the police accident report, as well as accident scene photographs taken by the owner of the other involved vehicle. Based upon the information in the police report and metadata from the photographs, investigators concluded that the accident occurred at approximately 5:15 AM on March 3, 2022, prior to the inception of Mills’ coverage. Mills received a sentence of time served to 23 months of incarceration. Further, he was ordered to pay $9,813.51 in restitution to Allstate Insurance for the cost of repairing the other involved vehicle and $200.00 to cover the other driver’s insurance deductible.
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 On January 17, 2024, Rebecca Albino was sentenced in Lancaster County after entering an open plea to one count of Insurance Fraud (M1). On July 1, 2021, Albino renewed the Erie Insurance Company policy covering her 2008 Chevrolet Colorado pickup truck. The policy listed Albino as the only insured driver and listed her husband as an excluded driver. On November 20, 2021, Albino reported to Erie Insurance that she had been driving her pickup truck when it was involved in a three-vehicle accident. During a recorded interview with an Erie representative, Albino stated that she had been driving home from work when the accident occurred. Erie issued a settlement check to Albino in the amount of $5,130.43 on November 23, 2021. However, Erie stopped payment of the check on December 6, 2021, after the drivers of the other involved vehicles advised that a male had been driving Albino’s pickup truck at the time of the accident. The other drivers provided investigators with photos they took at the accident scene, which clearly showed a male behind the wheel of Albino’s truck. Albino was sentenced to 24 months of probation and was ordered to complete 50 hours of community service. She was also ordered to pay a $250.00 fine and court costs.
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 On January 4, 2024, Mark Gamble was sentenced in Westmoreland County after entering an open plea to one count of Insurance Fraud (M1). Gamble was operating his 2002 Honda Civic between 6:00 AM and 7:00 AM on January 16, 2023, when it rear-ended a 2022 Toyota Tacoma. Gamble provided police and the driver of the other vehicle with documentation indicating that his Honda was covered by an Erie Insurance policy. Gamble contacted Erie later that day and made a payment to have his lapsed vehicle coverage reinstated. Gamble denied that his vehicle had incurred any damage or had been involved in any accidents during the lapse period. When the driver of the Toyota Tacoma contacted Erie to file a claim for his damaged vehicle, Erie advised him that Gamble’s policy was not in effect at the time of the accident. Gamble admitted to Erie during a recorded interview that he knew that he had no coverage at the time of the crash and that he provided invalid insurance information to the other driver and the police. The other driver subsequently filed a claim with his insurer, California Casualty, for the damage to his Toyota. Gamble was sentenced to a period of 24 months of probation and was ordered to complete 50 hours of community service. He was ordered to pay $1,000.00 in restitution to the other driver, which was the amount of that driver’s insurance deductible. Gamble also was ordered to pay court costs.
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Accelerated Rehabilitative Disposition (ARD)
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During the month of January, 11 additional defendants received
Accelerated Rehabilitative Disposition (ARD).
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Anti-Fraud Compliance
Reporting of Insurance Fraud to Law Enforcement Agency
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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.
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