Slip and fall scam takes insurance companies for millions

All over America con artists are ripping off stores by pretending to fall and get hurt. The price of these cons end up being passed on to the customers. FOX6 Investigators confronts one of the women accused of operating a massive slip and fall ring in Milwaukee.

Fraudulent slip and fall claims are up 25% since 2008 and federal records obtained by FOX6 show one of the most elaborate slip and fall rings in American was operating in Milwaukee.

Federal court records show Kimball Lewis admitted to taking part in a scheme to defraud retail stores and their insurance companies out of hundreds of thousands of dollars by submitting false claims for injuries arising from accidents that never took place.

National Insurance Crime Bureau (NICB) Special Agent Mark Sakalaras calls the slip and fall a "quick sit down".

The NICB maintains a database of questionable claims submitted to thousands of insurance companies across the country. According to the NICB, 2010 was a record year for phony falls.

Accidental slips, trips and falls are a huge liability for any retail store. Scammers try to exploit a store's willingness to quickly settle claims by staging fake accidents that are virtually impossible to disprove.

In Florida, a 72-year-old woman pours liquid on the floor in the cosmetic aisle, then returns a few minutes later to stage a fall. She wipes her shoe in the puddle, then deliberately sits down, leans back, fixes her fair and her partner in crime goes searching for help.

Seconds later, store workers come running to her aid and paramedics aren't far behind. Their execution was flawless until they got greedy and asked for $300,000.

Sakalaras says, "That's bold. That's extremely bold to go to that extent to think you're going to get away with it."

It works more often than you might think. Sakalaras says, "A lot of these are paid. Even the ones that are caught on video are still paid. A lot of them, not all of them, but a lot of them are still paid."

The insurance company pays the claim, but National Coalition Against Insurance Fraud Rep. James Quiggle says, "Fake slip and fall injuries come back to all of us in higher prices at the department store or grocery store. This is money out of our pockets in a lousy economy when average Americans are trying to make a decent living. It's not fair."

The scammers usually work in teams, but few are prolific as a band women accused of fleecing dozens of Milwaukee area retailers.

Kimball Lewis is just one of the players implicated by federal investigators in a scheme to rip off big box stores like Menards, TJ Maxx, Target, Michaels, Pick N' Save and more. According to court records filed by the US Postal Inspector, Lewis's mother Michelle Taylor was the ringleader.

Between September 2007 and March 2009, investigators say Taylor and her associates submitted 65 fraudulent claims seeking more than $200,000.

25 of those claims were submitted to Chicago-based Zurich North America Insurance and it was Zurich's internal investigators who discovered that eight of the claims contained an identical invoice from Great Lakes Radiology.

Five claims used identical receipts from Wheaton Franciscan and two claims used the exact same receipt from Aurora Medical Center.

In fact, six of the slip and fall claims were for accidents that occurred the very same day.

Lewis and her mother told investigators they got help from a woman named Debra Woody, who was a student in Sanford-Brown's medical billing program.

Woody allegedly had a blank medical files on a flash drive, which were edited to create the fake documents submitted with each claim.

According to Zuirch, 24 of the claims were faxed from Sanford-Brown's West Allis campus. Three of them were sent within 44 minutes and each for roughly $3,000-$5,000.

Sakalaras said, "It's a lot of money and this is just one group, one area. You know there's more than just one group that was doing this in Milwaukee County. These are the only ones who got caught."

Even when they do get caught, criminal charges are rare. Coalition Against Insurance Fraud Rep. James Quiggle says, "Prosecutors will save the resources for what they consider more violence crimes such as drugs, and burglary, murders and shootings."

Federal investigators name nineteen different people who may or may not have been willing participants in Milwaukee's slip and fall ring.

Michelle Taylor and Debra Woody are both serving prison time for unrelated fraud convictions.

Last fall, federal prosecutors filed criminal charges against Taylor for the slip and falls, but then quickly dropped the case.

A source close to the investigation says it's now before a grand jury and that an indictment could be coming in the near future.

Kimball Lewis has not been charged with anything, despite her alleged admission to a US Postal worker.

Prosecutions on these cases are so rare that the Milwaukee County District Attorney's Office can't remember prosecuting a single slip and fraud case.