Wednesday, August 12 2020

Insurance Fraud Unit

The Insurance Fraud Unit is funded primarily by the Insurance Fraud Reimbursement Program through the New Jersey Office of the Attorney General, Division of Criminal Justice, and Office of the Insurance Fraud Prosecutor (OIFP).

The Insurance Fraud Unit investigates all forms of insurance and insurance-related fraud including, but not limited to, health care, auto, homeowner’s insurance, workers’ compensation, simulated motor vehicle cards and arson. The Unit also provides investigative assistance to local police agencies. One assistant prosecutor, one detective, and one secretary are assigned to the Unit.

The Insurance Fraud Unit investigates and prosecutes cases on a vertical prosecution model, handling cases from inception to sentencing. Cases are developed from information provided by municipal police departments, insurance company anti-fraud units, the OIFP, the New Jersey Division of Consumer Affairs, the New Jersey Motor Vehicle Commission, the New Jersey Department of Health and Senior Services and information from concerned citizens.

In 2018, the Insurance Fraud Unit expanded the proactive initiative of working directly with Motor Vehicle Commission investigators targeting and investigating individuals fraudulently registering their motor vehicles in Burlington County. This initiative continues to lead to more investigations and the development of cases with stronger proofs.

The Insurance Fraud Unit also voluntarily developed and implemented a training presentation as part of the semi-annual Criminal Investigation Course which is offered to investigators throughout the county and the surrounding region. Course instruction also provides the platform to implement a new county-wide Prescription Fraud Form which better facilitates the investigation and prosecution of related insurance crimes.

SIGNIFICANT CASES PROSECUTED IN 2018

STATE V. DONALD HORNER

On October 1, 2018, Donald Horner was arrested by the Burlington County Prosecutor’s Office Insurance Fraud Unit and charged with Insurance Fraud and other related charges. The arrest of Donald Horner was the result of an investigation conducted by the Burlington County Prosecutor’s Office, Insurance Fraud Unit.  On June 26, 2018, investigators with the New Jersey Office of Emergency Management met with the BCPO Insurance Fraud Unit to discuss an alleged fraud committed by Delran Emergency Squad Chief Donald Horner. State Investigators received a tip that Horner was continuing to work on ambulances responding to calls, transporting patients, and billing for services without an active EMT certification.  Under the State licensure agreement for EMS agencies, two certified EMTs must be on the ambulance in order to bill for services.  According to State Investigators that went to Delran Emergency Squad in order to investigate the alleged offense, Horner made threats directed at them.

Over the course of the investigation, the BCPO Insurance Fraud Unit conducted numerous interviews and acquired records that contained audit trails showing all of Horner’s activity within the patient care reporting system used for each patient contact/ bill.  The audit trails showed that Horner would log in and alter patient care reports by removing his name off as a provider and add in a certified EMT who was not originally on the care report.  The investigation concluded that 27 patient care reports had been altered by Horner.  Out of these 27 patient care reports, 11 were used to bill private insurance providers $9,845.50 which led to Delran Emergency Squad receiving payment in the amount of $3,728.34.

On May 6, 2019, Donald Horner pled guilty to an accusation for Insurance Fraud (Third Degree) and Tampering with Public Records (Third Degree) for a negotiated sentence of 364 days in the Burlington County Jail, 200 hours of community service, forfeiture of his EMT certification for life, restitution, and mandatory fines and penalties.

STATE V. DIANDRE CHANDLER

On April 24, 2018 Diandre Chandler was indicted for Insurance Fraud (Third Degree). The investigation originated with a referral by the OIFP which was received by the Burlington County Prosecutor’s Office Insurance Fraud Unit on March 20, 2018 and involved a suspicious motor vehicle accident claim. A claim was submitted to Personal Service Insurance by Budget Rental Cars on behalf of their client, Diandre Chandler. The claim received by Personal Service Insurance was flagged as suspicious due to the fact that a tow slip indicated that the motor vehicle accident had happened two days prior to the submission of the claim, and one day prior to the inception of the defendant’s car insurance policy.

The BCPO Insurance Fraud Unit acquired the original motor vehicle accident report, tow slips, and the incident report submitted by Diandre Chandler. These documents revealed that the rental vehicle was being driven by Diandre Chandler’s girlfriend Natasha Phelps, who was involved in a motor vehicle accident involving a fixed object in South Brunswick, NJ on April 16, 2017. The accident report showed that Phelps was the driver, and there were no other occupants. The impound receipt also showed April 16, 2017 as the date of the accident. Chandler then opened a policy with Personal Service Insurance on April 18, 2017, and reported the accident as occurring on April 19, 2017, with him as the driver.

On December 3, 2018, Diandre Chandler pled guilty to Insurance Fraud (Third Degree) and was subsequently sentenced to probation, ordered to pay $5000 in restitution to Budget Rental Cars and also ordered to pay mandatory fines and penalties.

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