Healthcare and insurance fraud are two types of fraud that can occur in many different areas. This type of fraud usually involves multiple parties that each play a role in the alleged scheme; some may even be unaware that they are participating in the commission of fraud. Recently, multiple people were arrested in a relation to an insurance fraud scheme in Florida.
The alleged insurance fraud scheme involved a licensed massage therapist, 14 patients of a massage clinic and a physician's assistant. The insurance fraud arrests were based on the two criminal charges of insurance fraud and grand theft. The insurance theme was detected through the use of an undercover sting that was conducted by Florida police. The undercover officers were part of the Miami-Dade Public Corruption Investigations Bureau.
It was reported the insurance fraud scheme involved the owner of a Florida health company that allegedly charged insurance companies approximately $250,000 in fraudulent insurance claims. The allegations also state that the health company also convinced the patients to perpetuate fraudulent personal injury protection claims.
The undercover officers that were involved in the detection of the alleged insurance fraud posed undercover as patients of the health company. When the undercover police went to the health company, it is alleged that the health company had the officers pre-sign treatment forms that had yet to be completed.
It is also alleged they received coaching from the health company on how to respond to potential questions from their insurance companies. It has not been reported whether the suspects have been formally charged in association with the arrests. Insurance fraud is a serious and complicated offense. Defending against charges such as these requires not only an understanding of the medical field but the ability to scrutinize financial information.
Source: Insurance Journal, "Florida massage therapist, 14 patients charged with insurance fraud," April 23, 2012