Four women are accused of conspiring to rip off Aflac of thousands of dollars in fake insurance billings, according to the Florida Department of Financial Services. Three of the four women worked at a neurosurgery practice through which the claims were made. The women forged insurance billing forms, and progress notes for hospital visits that never occurred, and provided fake medical treatment to patients.
Uncovering the conspiracy
These conspiracies can go along for a while before anyone is caught. In this case, they had one of the defendants in their crosshairs. Certain claims were flagged as suspicious by Aflac and reported to authorities. These claims were almost identical to new claims that also appeared suspicious. A year later, the same defendant whose claim was denied and flagged submitted another claim. Hers was among a group of claims submitted by claimants all coming from the same IP address. These claims were all identical but for the names and addresses. They used similar billing codes, physician’s names, and other data, probably because they were using a template to forge the documents.
Among those charged with crimes is a woman who worked at the neurosurgery clinic through which many of the false claims were filed. The doctor who operated the clinic told investigators that some of the drugs he allegedly prescribed are drugs that he would never prescribe, one that he had never heard of before, and more that had no relevance to his practice. The doctor’s name was used to prescribe the controlled substances. One of the defendants had access to his medical records database and more.
Understanding the conspiracy
The four women are charged with filing false medical insurance claims and recovering thousands of dollars in fraudulent billings. They not only used their own names to pay for hospital stays that never occurred, they also used their family and children’s names. The money was paid out by the insurance company or (in some cases) the claim was denied. But since the services never existed, the conspiracy amounts to fraud.
While they did get away with the fraud for years, it is important to understand that on a long enough timescale, most do get caught. The defendant was still filing false billings while an active investigation was taking place. The fraud was easy for both the insurance company and investigators to spot because they already had one of the women’s names flagged and then they flagged every false claim that came from the same IP address. This resulted in the other women involved going down at the same time. Meanwhile, the doctor appears to have had no idea this was going on behind his back and will be more than willing to help the state make their case against the defendants.
Talk to a West Palm Beach Criminal Defense Attorney
If you are being charged with a scheme to defraud an insurance company, call the West Palm Beach criminal defense attorneys at The Skier Law Firm, P.A. today. The government does not always get it right and often, unwitting bystanders are dragged into the prosecution.