Wilson County man faces insurance fraud charges



SARATOGA — A Wilson County man is accused of lying about a car crash in order to collect an insurance claim.

Eric Deandre Hall, 32, of 7011 Page St., was arrested June 26 on one count each of insurance fraud and attempting to obtain property by false pretense and jailed under a $3,000 secured bond. The N.C. Department of Insurance announced the arrest on Monday.

Hall fraudulently claimed involvement in an April 4 wreck and tried to receive a medical payment from the United Services Automobile Association, according to Department of Insurance criminal investigators. Officials say Hall was not in the vehicle at the time of the crash.

“According to the FBI, insurance fraud costs the average family between $400 and $700 per year in the form of increased premiums,” state Insurance Commissioner Mike Causey said in a news release. “Consumer protection is my No. 1 priority and I will continue to fight insurance fraud with your help.”

The N.C. Department of Insurance employs 20 sworn law enforcement officers who investigate and prosecute claims of insurance and bail bonding fraud. To report suspected fraud, which can be done anonymously, call the department’s Criminal Investigations Division at 919-807-6840.

From staff reports




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National Insurance tax hit for gig economy firms





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Media captionMatthew Taylor: gig economy firms should pay national insurance on workers

One department is likely to be cheering the publication of the Mathew Taylor review into the new world of work.

The Treasury will be delighted with the recommendations from Mr Taylor, the head of the Royal Society of Arts, on gig economy companies.

He is recommending that firms which have a “controlling and supervisory” relationship with their workers would have to pay a full range of benefits.

That also includes millions of pounds in national insurance contributions.

In an interview with the BBC, Mr Taylor – head of the government’;s review into modern employment practices – said that such people were not self-employed as many gig firms insist.

“If you are being controlled and supervised you are probably a worker and you should get workers’; rights and also the employer that employs you should be paying national insurance,” Mr Taylor told me.

‘Control and supervision’;

I asked him if such a relationship encompassed firms like Deliveroo and Uber, which say that their riders and drivers are “self-employed” and have full flexibility to work when they want.

“We do not mention individual companies in our report, but I think that if you look at some of the big gig work platforms, at the present time you would say their business models look as though it may be that the people who work for them would be classified as workers rather than as self-employed,” he said.

Mr Taylor said: “If you look at the judgments that the judges have been making [about employment rights in the gig economy], it looks as though the courts are saying that it looks as though somebody is subject to control and supervision they should be described as a worker and not self-employed.

“Which, interestingly, is the same criterion used by the tax authority when they determine whether somebody is self-employed or an employee.

“We think that principle is right.”

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Image caption

Deliveroo riders could be in line for extra working rights

“Workers” – which Mr Taylor wants to redefine as “dependent contractors” – receive a wider range of benefits and protections compared with “self-employed” people, including sick pay, holiday entitlement and the minimum wage.

Firms which employ them are also obliged to pay national insurance contributions to HM Revenue and Customs at 13.8% of an employees’; earnings above £157 a week.

Although it is difficult to judge the economic value of the gig economy, more than one million people work in the sector.

If large numbers of them are reclassified as “dependent contractors” that could significantly increase taxes paid to the government by gig firms.

‘Fiscal headache’;

Mr Taylor told me that government tax receipts were negatively affected by the rapid growth in the number of “self-employed” people who pay lower levels of tax than fully employed workers.

“We have a big issue about the fact there is a gap between the amount of tax we pay on self-employed labour and employed labour,” he said.

“If you go back to the beginning of the welfare state, that difference was about 2-thirds – we paid 2-thirds as much for self-employed labour as we did for employed labour – now it is one-third.

“And at the same time self-employment has grown.

“So we are creating a fiscal headache for ourselves, and one of the things we say is over time we need to move to a situation where we pay a more similar amount.”

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Chancellor Philip Hammond had to U-turn on raising national insurance tax for self-employed workers

Mr Taylor said: “So it doesn’;t really matter if you’;re an employee or self-employed – if I pay for your labour, I should pay a similar amount of tax associated with the labour.

“Doing that, as the chancellor found out in March, is extremely difficult.”

In the Budget earlier in the year, Philip Hammond announced an increase in national insurance contributions paid by the self-employed.

He had to execute a U-turn a week later when it was pointed out that the move breached a Conservative pledge made at the time of the 2015 general election not to raise income tax, VAT or national insurance.

Zero hours contracts

Mr Taylor said it was time to ensure that the UK’;s strong ability to create employment was matched by the jobs being of good quality.

“We as a country have a great record on creating jobs and creating flexible jobs and flexible work is a good thing and most people who work flexibly – whether they are gig workers, zero hours workers, part time workers – enjoy working in a flexible way.

“But we have an issue with the quality of work in our economy. That issue is particularly problematic at the bottom end of the labour market for lower skilled workers.”

Mr Taylor said that zero hours contracts should not be banned – as Labour has demanded – but that people on them should be allowed the “right to request” a move to full-time employment, as the BBC revealed in May.

He admitted that it “would be hypocritical” if the review said they should be banned as the RSA uses them.

“I actually run an organisation that occasionally has zero-hours workers, they come and work when we have weddings in this house,” he told me, referring to the RSA’;s headquarters in central London.

“Most people who work zero hours chose to work that way.

“We shouldn’;t be in the business of trying to stop people doing something which works for them.”




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DOI_News_Header_2017.png

July 10, 2017





For Immediate Release: July 10, 2017

Contact: Bob Rosser or Colin Day at 919-807-6011

Wilson County Man Accused of Insurance Fraud

RALEIGH — Insurance Commissioner Mike Causey today announced the arrest of Eric Deandre Hall, 32, of 7011 Page St., Saratoga; he is charged with one count each of insurance fraud and attempting to obtain property by false pretense.

Department of Insurance criminal investigators accuse Hall of fraudulently claiming he was injured in an automobile accident that occurred on April 4, 2017, to receive medical payment from United Services Automobile Association. Investigators allege Hall was not in the vehicle at the time of the accident.

Hall was arrested on June 26 in Wilson County and was placed under a $3,000 bond.

“According to the FBI, insurance fraud costs the average family between $400 and $700 per year in the form of increased premiums,” said Commissioner Causey. “Consumer protection is my number one priority and I will continue to fight insurance fraud with your help.”

The Department of Insurance employs 20 sworn state law enforcement officers dedicated to investigating and prosecuting claims of insurance and bail bonding fraud. To report suspected fraud, contact the Department of Insurance Criminal Investigations Division at 919-807-6840. Callers may remain anonymous. Information is also available at www.ncdoi.com.

–NCDOI–





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AG's office warns of health insurance scam



The Nebraska Attorney General’;s Office on Monday warned people to watch out for a scam involving health insurance coverage.

The office said it received reports of scam artists based in Florida posing as Blue Cross and Blue Shield of Nebraska representatives. The scam artists use fake web listings bearing Blue Cross’s logo and web address, along with fake addresses in Omaha. Investigators employed by Blue Cross believe the scam is affiliated with an entity called Simple Health based out of Hollywood, Florida. The scam artists collect personal information and offer insurance plans well below market value. Victims have reported online that the company charges their credit card monthly but never provides insurance cards or proof of coverage. The company also makes it difficult to cancel.

The Attorney General’;s office said consumers should be wary of calling any telephone number other than one available on Blue Cross’;s official web page. Those who may have been victimized by the scam should contact the Attorney General’s Consumer Protection Division at 800-727-6432.




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How Are State Disability Insurance



In my recent posts, we’ve discussed how payroll taxes are calculated across many different areas; state income taxes, social security and medicare taxes, federal income tax withholding and more. Today we’ll dive into state disability insurance (SDI) and how it is calculated. The 5 states listed below are the 5 that have a form of SDI or temporary disability insurance (TDI) that are withheld from employee paychecks. 

State Rate Max Withheld Annual Wage Max
California 0.900% $998.12/year $110,902
Rhode Island 1.200% $817.20/year $ 68,100
New Jersey* 0.765% $256.28/year $ 33,500
Hawaii 0.500% $ 5.12/week        –  
New York 0.500% $0.60/week        –  

*This is a total of the New Jersey employee SDI, unemployment, workforce development, and family leave insurances.

California State Disability Insurance (SDI)

California employers are required to withhold state disability insurance from employee paychecks at a rate of 0.9% on wages up to a maximum of $110,902 for 2017. The California State Disability Insurance (SDI) program provides short-term disability insurance and paid family leave wage replacement benefits to eligible workers.

The wages are determined as follows:

Gross Pay (including tips and taxable fringe benefits including employer contributions to HSA plans).

  • Less: Section 125 deductions (medical, dental, vision, dependent care, pre-tax commuter benefits, etc.) HSA deductions are not subtracted.
  • Equals: Wages for CA SDI

Example:

Bob is paid semi-monthly. On this paycheck, he earned $8,000 in salary. In addition, Bob gets a semi-monthly auto allowance of $1,000. He has an HSA deduction of $500, and his employer contributes $250 to his HSA. Bob has a dental deduction of $100 and he also contributes 10% of his income to his 401k. What’s Bob’s taxable income for CA SDI?


*401(k) and HSA deductions do not reduce gross pay for calculating California SDI.

Rhode Island Temporary Disability Insurance (TDI)

Rhode Island requires employers withhold 1.2% of the first $ 68,100 of employee wages for Temporary Disability Insurance. The insurance protects workers against wage loss resulting from a non-work related illness or injury, and is funded exclusively by Rhode Island workers. The calculation is similar to California, but the definition of wages is different. Rhode Island does not increase wages for employer contributions to HSA, and deferred compensation reduces the wages in the tax calculation. In our example for Bob above, Rhode Island TDI would be calculated as follows:

Example: Rhode Island TDI based on Bob’s information above:

New Jersey Disability, Unemployment, Family Leave, and Worker’s Development Insurance

New Jersey requires the withholding on employee taxes for state disability, unemployment, family leave, and workforce development insurance (the employer also pays taxes on this as well). The employee tax rates for New Jersey are broken down as follows:

Employee Tax Rate
State Unemployment Tax Act (SUTA) 0.3825%
State Disability Insurance (SDI) 0.2400%

Workforce Development (WFI)

0.0425%
Family Leave Insurance (FLI)  0.1000%
Total Tax Rate

0.7650%


The wages used to calculate the taxes are reduced by benefit deductions, but deferred income does not reduce these wages. If we use Bob as our example again, his New Jersey SDI, SUTA, WFI, and FLI taxes would be calculated as follows:

Example:  NJ SDI, SUTA, WFI & FLI taxes based on Bob’s information above:

Hawaii TDI

Employers in Hawaii are required by law to provide temporary disability insurance (TDI) coverage for eligible employees. This helps to cover non-work related injury or sickness, including pregnancy. Employers can choose to cover the entire cost, or to withhold up to 0.5% of eligible employees’ wages (up to 5.12 per week) towards the cost. Learn more here.

Employers can purchase TDI from an authorized insurance carrier or establish a self-funded plan. Payroll providers will withhold TDI taxes from employees if their employer elects to have employees contribute, but will not pay the amounts to the carrier. The funds remain in the company’s account, and the employer is responsible for paying these amounts to the carrier.

New York SDI

Similar to Hawaii, employers in New York are required by law to provide SDI (State Disability Insurance) coverage for eligible employees to cover off-the-job injury or illness. Employers can choose to cover the entire cost or withhold $0.60/week of eligible employees’ wages to share the cost of coverage. Payroll providers can withhold these SDI amounts from employees, but will not pay those funds to the carrier. Learn more.

Example:  Here is how Bob’s semi-monthly Hawaii TDI and New York SDI would be calculated:

As we have seen, there are only 5 states with State or Temporary Disability taxes, and each have their own system for calculating the withholding. California, Rhode Island, and New Jersey administer the state disability insurance. Hawaii and New York expect employers to have their own insurance policies, but allow employers to withhold some amounts to help pay for those policies.




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Does homeowners insurance cover fire damage?



Summer is usually the time for fire season and California has recently seen its fair share of it.

In Butte County, firefighters are currently working on containing the Wall Fire while residents deal with evacuation orders, leaving homes unattended.

A lot of people want protection for their houses in case of emergencies. So, what coverage is required? If your house catches on fire, then would the coverage be under homeowners insurance policies?

Allstate Insurance Company defines homeowners insurance as a plan that, “typically provides protection for your home and belongings.” Homeowners insurance can help protect a lot, including fires.

Dwelling insurance, which is part of the homeowner’;s insurance policy, helps pay for repairs of the physical structure of your house that’;s damaged by a hazard. The key is it must be directly attached to a home’;s structure. Because if it’;s not, then it’;s classified under what’;s commonly called the “other structures coverage.”

The dwelling insurance coverage includes fires, hail, windstorms and a few more, according to Allstate.

Also, under Nationwide’;s standard dwelling insurance policy, coverage includes many of the same hazards as the homeowners insurance policy. An example would be if a fire damages a section of a home, which may include a wooden deck attached to the back of the home, then the insurance would cover the rebuild or repair costs for the deck and home.

Unlike fire damage, most insurance companies actually have to purchase flood or earthquake insurance because it’;s not covered by the standard homeowners policies.

Depending on your service provider and specific policy, it may not cover the entire cost for rebuilding, even if it’;s a covered loss event.

© 2017 KXTV-TV




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Is Donald Trump responsible for rising health insurance premiums, as Chris Murphy said?



Sen. Chris Murphy, D-Conn., blamed President Donald Trump for insurance rate hikes through the administration’s attempts to weaken the Affordable Care Act.

“It all started when he issued an executive order … that commanded all federal agencies to start undermining the ACA, and his agencies listened,” Murphy said in the June 26 video. “The IRS decided to stop enforcing the individual mandate that was the underpinning of the ACA. That has resulted in insurance companies all across the country jacking their rates up, explicitly because they don’;t believe that healthy people will buy insurance.”

Insurance rates have indeed been on the rise, but we wondered whether it could all be traced back to the IRS and a weakened enforcement of the individual mandate.

We found that Trump has continued the weak enforcement of the individual mandate in place during the Obama administration, freezing a change that was set to begin with the 2016 tax year.

But his party’s rhetoric on repealing the Affordable Care Act, as well as other issues, have been linked to premium rate increases.

The role of the IRS

The IRS is the agency tasked with enforcing the Affordable Care Act’s individual mandate, which requires most individuals to obtain health insurance or pay a tax penalty for going without.

The mandate was designed to encourage healthy people to enter the risk pool and thus lower insurance costs.

When people file their individual income tax returns, they must indicate their health insurance coverage or list a waiver or exemption. Otherwise, they must pay the penalty for lacking coverage. For the 2016 tax year, those who weren’t covered had to pay 2.5 percent of taxable income or $695, whichever was higher.

Those tax returns that failed to do any of these 3 actions were considered “silent returns,” and elicited a letter from the IRS alerting the taxpayer of the issue.

“Most of the time the taxpayer didn’t get back, and there was nothing else the IRS could do,” said Chris Condeluci, a former Republican tax counsel to the Senate Finance Committee when the Affordable Care Act was writ8.

President Barack Obama instructed the IRS to stop processing silent returns beginning with 2016 tax filings to punish taxpayers expecting a refund who failed to comply with the law.

Trump’s executive order scrapped that change.

“Processing silent returns means that taxpayer returns are not systematically rejected by the IRS at the time of filing, allowing the returns to be processed and minimizing burden on taxpayers, including those expecting a refund,” the IRS said in a Feb. 15 press release. “When the IRS has questions about a tax return, taxpayers may receive follow-up questions and correspondence at a future date, after the filing process is completed. This is similar to how we handled this in previous years, and this reflects the normal IRS post-filing compliance procedures that we follow.”

Murphy’s team pointed us to that announcement when we asked for evidence for Murphy’s statement.

Trump’s order did cause the IRS to change direction internally, but outwardly, the agency is enforcing the same policy. “They’re adhering to the same enforcement policy as the Obama administration did. At the end of the day it’s merely business as usual when it comes to the IRS,” Condeluci added.

The IRS may have maintained the status quo, but the announcement still made an impact.

“It was noted by the actuaries who calculate rates. But it’s another element in a complex mosaic in factors that lead to rate increases,” said Dan Mendelson, the president of Avalere, a health care consulting firm.

Then there’s Congress.

Regardless of the Trump administration’s impact on the IRS, Congress is working to effectively scrap the individual mandate. The House Committee on Appropriations has drafted a bill that would terminate the tax penalty on those who go without insurance, which the House Subcommittee on Financial Services and General Government approved on June 29.

Premiums on the rise

Insurance rates for the most popular type of exchange plan are an average of 18 percent higher than last year, according to Avalere. A combination of medical inflation and political volatility account for the hike, although it’s hard to apportion the causes of the rate increases. The individual mandate isn’t the only factor, though.

“Although the mandate is a reason for higher premiums for next year, it’;s probably not the main reason,” said Sherry Glied, the dean of New York University’s Graduate School of Public Service. “The main reason is uncertainty about whether Congress will fund the ACA’s cost-sharing reductions.”

That’;s a different animal.

Congress is weighing whether to continue funding the $8 billion pool of cost-sharing reduction subsidies under the ACA. In 2010, the House filed a lawsuit arguing the subsidies were illegal, and the Trump administration has not clarified whether it will defend them in court. The bipartisan budget bill passed late June did not include those funds.

“This is one of the larger premium hikes because there’;s a lot of uncertainty about what’s going to happen to the insurance marketplace,” said Claire Brindis, the director of the Institute for Health Policy Studies at the University of California, San Francisco. “Whenever insurance companies feel like there’;s going to be dramatic changes, they get skittish about profit margins.”

Our ruling

Murphy said that insurance companies are jacking up their rates because of the IRS’ weakened enforcement of the individual mandate under Trump.

That’s an exaggeration. The Trump administration has continued the same policies as Obama. A mandate to buy insurance is in place, but there’s not much punishment for those who refused to comply.

Murphy suggested that the individual mandate itself was key in keeping insurance rates low. In theory, the requirement invites greater diversity to the health insurance risk pool, but the IRS never had sufficient tools at its disposal to enforce it effectively.

Blaming rate increases on the IRS is too simplistic, particularly as there is no evidence of a direct link. A number of other factors are at play, including uncertainty around future health care subsidies.

Because there has been little outward change in the IRS enforcement policies, we rate this statement Mostly False.

Share the Facts

2017-07-10 18:46:47 UTC

3

1

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PolitiFact rating logo PolitiFact Rating:

Mostly False

Says because of Donald Trump, “the IRS decided to stop enforcing the individual mandate that was the underpinning of the ACA. That has resulted in insurance companies all across the country jacking their rates up, explicitly because they don’;t believe that healthy people will buy insurance.”

Chris Murphy

Connecticut senator

in a video

Monday, June 26, 2017

2017-06-26




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CNN panelist: Health insurance should work like car insurance



Having a good driving record lets you pay less for auto insurance than someone who crashes into trees a lot. A leading conservative argued Monday that the same logic should work in health care:

Stephen Moore, a visiting fellow and economist at the Heritage Foundation, a conservative think tank, reasoned that people who make personal lifestyle choices to be healthy should be rewarded with cheaper insurance than those who end up sick and cost more to cover.


Moore, who also served as an economic adviser to President Donald Trump during his campaign, made the auto-health connection on CNN’;s New Day with Alisyn Camerota:

“Health insurance should work like auto insurance,” he said. “If I have a very good driving record, Alisyn, and you don’;t, I shouldn’;t have to pay the same premiums as you do. Look, we know that a lot of health outcomes, about, at least half, have to do with people’;s personal decisions about smoking, about overeating, about not exercising, about not getting enough sleep. It’;s not fair for people who lead healthy lifestyles to have to pay more for their insurance for people who don’;t.”

If that reasoning sounds familiar it might be because 2 months ago, U.S. Rep. Mo Brooks, R-Ala., landed in some hot water for his speculation, also on CNN, that “people who live good lives don’;t have to worry about pre-existing conditions.”

Brooks, realizing he might be coming off as insensitive to those who perhaps develop Multiple Sclerosis or are born with birth defects,  walked the comment back and suggested society had an obligation to those who get sick through no fault of their own.

In fact, the assertion that people have complete control over their health has long brought howls from the medical and public-health community who say bad things do, indeed, happen to good people. 

In Texas, the Kaiser Family Foundation, has estimated about 27 percent of its adults under 65 had a health condition before the Affordable Care Act that could lead them to be declined for coverage. 

The GOP- backed health bill to repeal the ACA, also known as Obamacare, favored putting sick people in high risk-pools to save healthier people from having to foot their higher costs.

While the Senate version, still awaiting a vote, made no specific mention of high risk pools it does give more freedom to craft plans that could cover less.

RELATED: Celebration, fear greet House passage of health care bill

Then there’;s the proposal being floated these days, this one by U.S. Sen. Ted Cruz,, R-Texas, which allows the skimpier plans as long as the insurance industry offers at least one plan that covers people with pre-existing conditions in the same way the Affordable Care Act does.

RELATED: Ted Cruz says Senate health plan still not meeting his objectives





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Insurance to cover electronics



Hi

For the people that have been or have sorted the insurance, has anyone managed to find a policy to cover the electronics in the hold luggage?

I am looking for one but finding it hard to fine one that actually covers electronics in the hold

Any ideas?




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Medicaid group pans key insurance provision of Senate GOP bill



A provision in the Senate GOP’s ObamaCare repeal bill that would penalize people for being uninsured wouldn’t be enough to prevent a “death spiral” in the insurance marketplace, according to safety-net insurance plans.

In a letter sent Monday to Senate Republican leaders, the Association for Community Affiliated Plans (ACAP) said the bill’s 6-month “lockout” provision won’t be enough of an incentive “for consumers who otherwise would not purchase coverage.”

“The possibility of an additional 6 months … is not enough to change the calculus for someone who is generally healthy and willing to risk waiting until the next open enrollment period,” ACAP wrote. “[T]his provision is not enough to prevent the ‘death-spiral’ that is sure to otherwise occur if the BCRA is implemented.”

The Senate bill would make those who had a lapse in coverage for 63 days or more wait 6 months before obtaining insurance. The provision addresses concerns that people would only sign up for health coverage when they’re sick if insurers can’;t deny coverage for pre-existing conditions.  

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The policy was added to the legislation as a way to prevent a “death spiral” in insurance markets. Experts have long warned that only sick people buying insurance would lead to massive premiums and the destabilization, and eventual collapse, of the individual insurance markets.

ACAP represents Medicaid plans that have more than 20 million enrollees in 29 states. The group previously said it opposed the Senate’s legislation because of the “massive cuts to federal Medicaid funding.”

Last month, ACAP launched a 6-figure ad buy urging GOP senators from swing states to oppose the bill’s Medicaid cuts.

According to the group, the 6-month penalty “may do a little around the edges to ensure continuous coverage … it will do little to incentivize currently uninsured consumers, especially those that are young and healthy, to purchase coverage and thus do little to balance the risk pool.”




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