Each year, the Coalition Against Insurance Fraud identifies the individuals who have taken the term "bad actor" to a new level. This year's entrants into the Hall of Shame thought nothing of committing murder, medical malpractice, theft and betrayal, fraud, arson and faking a disability. These creative bad actors defrauded multiple lines of insurance and never considered the consequences to themselves or others. Read on to learn about the people who shamelessly thought they could commit crimes without being caught.
Life insurance
Killer watched TV crime shows for murder and cover-up ideas
In a real-life plot twist fit for a poorly written crime show, Cory Martin — a New York City resident — found himself at the center of a grisly murder trial that even Netflix might pass on. Martin, now 36, was recently convicted of strangling Brandy Odom, a woman he had trafficked, in a chilling murder-for-hire scheme. But the real kicker? He allegedly relied on crime shows like Dexter and The First 48 for tips on how to pull off his gruesome act without getting caught. Spoiler alert: it didn't work.
The story begins with Martin's dark, twisted idea to cash in on two life insurance policies fraudulently taken out in Odom's name. Authorities say he strangled her in April 2018 and, in a scene right out of a midnight thriller, dismembered her body to make disposal easier. His partner-in-crime, Adelle Anderson, was also in on the plan but later took the witness stand to spill the beans, detailing how Martin's obsession with crime shows supposedly guided their strategy.
The TV-inspired criminal apparently thought that watching Dexter, the show about a "moral" serial killer who dismembered his victims, would make him an expert in forensics. Anderson claims the pair used these shows to decide on the "dos and don'ts" of cover-ups. Step one: don't learn actual forensic science; instead, binge crime dramas. Step two: attempt to hide a dismemberment with, you guessed it, heavy-duty garbage bags. But as any true-crime enthusiast knows, poorly executed plans, much like spoilers, always seem to come back to haunt you.
After the murder, Anderson says Martin stocked up on cleaning supplies and garbage bags for the bloody task. In a bone-chilling feat of "amateur hour," they scattered Odom's remains across a Brooklyn park, seemingly unaware that their disjointed attempts at crime scene "cleanup" weren't going to fool anyone.
Breon Peace, U.S. Attorney for the Eastern District of New York, didn't mince words, calling Martin's act a tragic exploitation of a woman he saw only as his "moneymaker." As for Martin, he may now have plenty of time to ponder his crime show lessons from behind bars — just without a remote control this time.
Workers' compensation
When acupuncture goes off the rails
It turns out that acupuncture doesn't just relieve pain — it also, apparently, works wonders for pulling off a $9 million insurance scam. Punson Figueroa, a New York acupuncturist and now self-admitted fraudster, has pleaded guilty to a scheme that bled Amtrak's health benefits program dry. Federal agents uncovered her multi-million-dollar magic trick, and it seems Figueroa's "treatment plan" was more about fattening her wallet than easing anyone's aches.
Dubbed the "mastermind" behind this railway robbery, Figueroa recruited a colorful crew of accomplices, ranging from ex-Amtrak employee Devon Burt to New Jersey doctor Muhammad Mirza. Together, they managed to bill Amtrak's health insurance for procedures that were either medically unnecessary or simply... imaginary. Apparently, when it comes to fleecing a federal benefits program, imagination goes a long way.
The scam was simple but effective: Figueroa and her team would gather Amtrak employees' health insurance details, sign off on bogus treatments, and kick back cash rewards to their compliant "patients." In a stroke of irony that belongs in a crime novel, an undercover federal agent posing as a patient played along, signing his name on about 30 blank forms at Figueroa's direction. No dates required — just a steady hand and a trust fund of Amtrak health dollars waiting to be tapped.
For his troubles, the undercover agent received a cool $1,000 in cash, while Amtrak's insurance forked over more than $31,000 for the phantom treatments. But the charade couldn't last forever. After a nationwide sweep targeting healthcare fraudsters, Figueroa was snagged alongside 90 other defendants, all part of the FBI's two-week hunt for scammers billing over $2.6 billion in false claims.
The fallout? Figueroa could be trading her acupuncture needles for prison bars, with up to 10 years in jail and a hefty $250,000 fine. And while Amtrak's Chief of Police Sam Dotson touted the case as a win for justice, one can't help but imagine Figueroa is out there somewhere, rethinking her binge-watching choices.
After all, maybe she should've studied a little less Grey's Anatomy and a little more Law & Order.
Medical claims
A medical biller posed as an NBA star and thought no one would notice
Matthew James had big dreams — not of playing in the NBA, mind you, but of impersonating NBA players (and others) in an elaborate insurance fraud scheme. The 54-year-old medical biller, recently sentenced to 12 years in federal prison, took the art of "pretending to be someone else" to a new level. Among his greatest hits? Posing as NBA star Marcus Smart, demanding insurance payouts with the tenacity of a player chasing a championship.
James ran a medical billing company that, apparently, had a side business in creative identity theft. When insurers refused to pay up on the fraudulent claims, James didn't back down. No, he'd grab the phone, impersonate a high-profile policyholder, and raise a racket. "How dare you charge ME for this procedure?" we imagine him bellowing into the receiver, channeling his inner NBA drama.
His schemes didn't stop at athletes, though. James went on to impersonate none other than Jeff Pash, an executive and lawyer for the NFL. Picture the scene: a phone call from "Pash" ranting and swearing at a hapless insurance rep. Only it wasn't actually Pash, but rather James, throwing in a bit of high-octane outrage to pressure insurers. NFL staff were likely wondering if someone had intercepted the hotline.
Real-life Marcus Smart even testified, saying he was horrified that someone had used his identity to run an insurance con. As a role model and defensive ace, the real Smart isn't exactly thrilled to be dragged into this. And who could blame him? The last thing an NBA star needs is someone trashing his reputation over fake medical bills.
James's lawyer has claimed his client deeply regrets the whole thing, attributing it to a recent drinking problem and family pressures. "An aberration," the lawyer called it. But for an "aberration," it netted James hundreds of millions in fraudulent insurance claims.
So, let's all take a lesson here: If you ever feel the urge to impersonate an NBA player, maybe stick to Halloween.
Health insurance
Medicaid fraud scheme nets over $93 million and 14 years in jail
Once again, Florida doesn't disappoint on the "seriously?" front. This time, it involves Karel Felipe, 42, and Tamara Quicutis, 54, who were recently sentenced for pulling off a Medicare fraud scheme worth over $93 million. That's right, a Miami Shores man and a Hialeah woman cooked up a plan to bill Medicare for non-existent home health services, ultimately landing them behind bars for a combined 14 years.
It all started with a cast of characters straight out of a crime novel. Felipe and Quicutis worked with co-conspirators who helped set up three fake home health companies in Michigan. (Apparently, the Sunshine State was a bit too close for comfort?) They roped in folks from Cuba to pose as the "owners" of these agencies to hide the real puppet masters pulling the strings — Felipe and Quicutis. The alleged owners even signed Medicare paperwork to make it all look nice and official.
Once the "owners" were in place, the crew got creative with billing. Medicare was sent invoices for countless hours of therapy sessions and health services that never happened. Using stolen patient identities, they filed claims as fast as their fingers could type. And when the money started rolling in, Felipe and friends didn't waste any time. They set up dozens of shell companies and hundreds of bank accounts to launder the cash, hitting Miami ATMs to turn those fraud profits into cash.
But Felipe and Quicutis weren't the only ones enjoying the Medicare money shower. Four other Florida residents also joined the ranks of the convicted. The highlight reel includes Jesus Trujillo, sentenced to 14 years and ordered to hand over $44 million — plus a couple of properties for good measure. Talk about a luxury forfeiture package!
Authorities, including the FBI and HHS-OIG, were all over this scheme. As for Felipe and Quicutis, they'll have plenty of time in federal prison to think about their next career moves.
Healthcare
Veterans convicted in a $65 million compound medication con on Tricare
In a fraud case that nearly tipped the military's health insurer, Tricare, into bankruptcy, two veterans have learned the hard way that playing doctor isn't all it's cracked up to be. Former U.S. Marine Joshua Morgan, 31, and former U.S. Navy sailor Kyle Adams, 36, were recently sentenced for their roles in a scheme that scammed over $65 million from Tricare.
Morgan, stationed at California's Miramar Air Station, will spend 21 months in federal prison and pay $4.4 million in restitution. Adams received a 15-month sentence along with a hefty $11.5 million payback order. Both men were part of a twisted recruitment operation with a "too-good-to-be-true" offer for service members: free money in exchange for "medical evaluations." That meant signing up for pricey meds like custom creams and — you guessed it — erectile dysfunction pills. What these service members didn't know was that the "evaluation" was just a smokescreen for a massive insurance swindle.
The duo worked under Jimmy and Ashley Collins, a Tennessee couple with entrepreneurial (read: criminal) ambition. They paid service members $300 a month to participate, then billed Tricare for exorbitant compound medications, cashing in millions in reimbursements. Morgan, in the spirit of "I need a new car," pocketed $2.6 million, reportedly splurging on luxury cars, nightlife, and premium booze — truly living the fraudulent high life until, well, it all came crashing down. Adams earned a cool million recruiting 88 people, eventually confessing he "just went with it." After all, who can resist a money flood?
The supporting cast included doctors Carl Lindblad and Susan Vergot, and nurse practitioner Candace Craven, who signed off on the fake prescriptions. Not to be outdone, CFK Inc., the pharmacy behind the medications, admitted to its role in the racket back in 2019. As for the masterminds, the Collins duo, they've each received their own blend of prison and home confinement sentences, along with an eye-watering $65 million restitution bill.
So, what's the moral of this saga? Maybe it's that free cash usually comes at a cost — particularly when it's tied to overpriced cream.
Inside agent
Ex-insurance commissioner pleads guilty in $260,000 kickback scheme
In a plot twist straight out of "What not to do as a Public Official," former Georgia insurance commissioner John W. Oxendine has pled guilty to healthcare fraud. His crime? Directing doctors to order a slew of medically unnecessary tests, all in cahoots with his buddy, Dr. Jeffrey Gallups. The payoff: hundreds of thousands in kickbacks, a fancy Ritz Carlton presentation to recruit more doctors, and, presumably, a spectacular lack of shame.
Now, you might think that a former state insurance commissioner would know a thing or two about honest dealings. But Oxendine, it seems, had other ideas. He teamed up with Dr. Gallups to funnel a Texas lab, Next Health, endless referrals for pricey genetic tests that most patients probably couldn't even pronounce, let alone need. In exchange, Next Health cut the duo 50% of the net profits on these "eligible specimens," racking up nearly $2.5 million in claims. Insurance companies footed about $700,000 of the bill, while Next Health kicked $260,000 back to Oxendine and Gallups.
Of course, all this didn't happen without a little finesse. Oxendine held a fancy presentation at the Ritz Carlton, where he "encouraged" doctors in Gallups' practice to get on board with the scheme. Those who didn't comply? Well, let's just say they probably didn't get invited to the afterparty.
When a compliance officer at the practice raised concerns, Oxendine didn't just ignore it — he doubled down, coaching Gallups to spin the kickback payments as "loans." And when the Atlanta Journal-Constitution investigated, Oxendine did what any ex-public official caught with his hand in the cookie jar would do: he flat-out lied.
So, what's the takeaway? Maybe it's that crime doesn't pay — unless it's a $260,000 kickback disguised as "loans." And if you're going to concoct a scheme involving unnecessary medical tests, maybe skip the high-profile hotel presentations. Or, better yet, skip the scheme altogether.
Auto claims
Orchestrator of a $60 million auto scam gets 10 years in prison
Move over, Wall Street — there's a new financial "genius" in town. Meet Bradley Pierre, a New Jersey resident who masterminded a $60 million scam targeting New York's no-fault auto insurance system. With a scheme that stretched over 13 years and spanned medical clinics, pharmacies, law firms (including his wife's!), and more bribery than a Hollywood heist movie, Pierre's story is both brazen and bizarre.
Sentenced to 10 years in prison, Pierre's tale is a case study in opportunistic greed. Operating under the radar since 2008, he exploited New York's no-fault insurance laws, which mandate that insurers cover certain accident-related medical claims without question — provided they're legit. Pierre's approach? "Why bother with legitimate when you can fake it?"
To pull off his scheme, Pierre took control of medical clinics like Veda Medical and Sun Medical, even though non-physicians legally can't own them. How did he get around that? Simple. He convinced actual doctors to pose as owners on paper, then coached them to lie under oath about who really called the shots (hint: it wasn't the doctors). Through these clinics, Pierre pocketed more than $20 million, steering patients to his preferred pharmacies and even his wife's law firm for legal representation. As a bonus, he made sure all those referral checks landed safely in his bank account.
Pierre channeled his clinic profits into luxury items such as his wedding, home makeovers, jewelry, and fancy vacations. And for his pièce de résistance, he tried to pull a Houdini on the IRS, stashing income, creating "phantom" business expenses, and underreporting $4 million in personal splurges. In total, he cheated the taxman out of a tidy $1.5 million.
But alas, all good scams must come to an end. Pierre's downfall finally came, and with his guilty plea, he's off to a federal facility for the next decade, with a side order of $3.5 million in forfeitures and $1.5 million in restitution.
Disability claims
New Hampshire man fakes disability to receive over $600,000 in VA benefits
In a jaw-dropping tale of deception, Christopher Stultz from Antrim, N.H., had been playing the disability fraud game for two decades. This master of disguise wheeled himself into VA medical centers, putting on quite the performance, and then strolled right out as if he were an Olympic athlete.
Stultz convinced the VA that he was 100% disabled, raking in $662,000 in benefits. Not content with just living off his ill-gotten gains, he also managed to secure special vehicles meant for mobility-impaired veterans — only to turn around and sell them off for some extra cash.
This elaborate deception began after his Navy days, thanks to an unfortunate fall from a horse. By 2003, his "horse story" had earned him a golden ticket: a 100% disability rating from the VA. But as we all know, the truth has a way of catching up with you, and investigators started to notice that Stultz was more mobile than his paperwork suggested.
Enter the VA Office of the Inspector General, who sniffed out this scam. The authorities were on to him, and in January, Stultz pleaded guilty to making false statements. For his long-running scheme, he was sentenced to 18 months in prison, followed by three years of supervised release and he was also ordered to repay the VA.
Property damage
Venice man conspires to burn multiple Illinois properties for insurance
In a fiery turn of events that's hotter than a summer day in the Midwest, Rufis A. Jefferson from Venice, Illinois, has found himself in hot water—literally and figuratively! This 47-year-old has gone from being an average Joe to a convicted arsonist after pleading guilty in federal court to a sizzling scheme involving not just one, but 14 felonies! Talk about igniting a passion for crime!
Jefferson was caught red-handed in a scheme that involved setting his relative's St. Louis apartment ablaze to cash in on a staggering $30,000 in insurance claims. I guess you could say he really took "playing with fire" to a whole new level! But, in a plot twist straight out of a crime drama, it turns out his grand plan went up in smoke — thanks to an undercover ATF informant who recorded their chats. Who knew that Jefferson's conversation about "lighting things up" would end with him lighting up a courtroom instead?
In an unfortunate turn of events, Jefferson isn't the only one on the fire line; his relative, Evette B. Osuegbu, is also facing the heat for her role in this blazing betrayal. With both of them now marked for a one-way ticket to prison, it's clear that their attempt to turn up the heat on insurance fraud has landed them both in a very chilly situation.
As U.S. Attorney Rachelle Aud Crowe put it, "Arson is a dangerous act of violence," and boy, did Jefferson's plan seriously backfire! It's safe to say that he's gone from wanting to collect a cool cash payout to potentially spending 20 years behind bars—his sentencing is set for February 5, 2025.
So, what's the moral of this scorching saga? When you play with fire, you're bound to get burned! Jefferson lit the wrong match this time, and let's just say, his future is looking as dim as the ashes he leaves behind. Talk about a classic case of going from flame to shame!
Pet insurance
Georgia "dog mom" faces 48 counts of pet insurance fraud and forgery
In a tail-wagging tale of deceit, Amanda Lindley from Dallas is barking up the wrong tree after being charged with a whopping 48 counts each of insurance fraud and forgery!
This crafty pet owner decided to take "dog mom" to a whole new level between January 2019 and December 2022 by claiming her beloved pup received lavish veterinary care from several clinics in Atlanta. Who knew that her dog was living the high life while she was concocting a scandal worthy of a soap opera?
Insurance and safety fire commissioner John F. King revealed that Lindley didn't just fetch her dog's bills — she went full-on magician, altering dates and costs on invoices to make it seem like her furry friend needed a small fortune in medical attention. We're talking about a pooch who apparently required treatment that would make even the most pampered pets blush! Thanks to her creative accounting, she managed to rake in nearly $45,000 in false claims. That's a lot of kibble!
But wait, there's more! In a move that could only be described as "paw-sitively" outrageous, Lindley also used these doctored invoices to solicit sympathy donations online. Imagine potential donors thinking they were helping a poor, ailing dog, only to find out they were funding a canine con artist's luxurious lifestyle. The audacity!
Now, with warrants out for her arrest since January 10, 2024, Lindley is still on the lam, with law enforcement hot on her trail. The investigation is firmly in the paws of the Paulding County Sheriff's Office, who must be wondering if they'll find her in a dog park or hiding out in a pet store, living large on her ill-gotten gains.
It's a woof of a story that shows just how far some will go to pamper their pets — though it looks like this dog mom's fraudulent claims have landed her in quite the "ruff" situation!
