Beware of Rising Premiums

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Binary data with the word IDENTITY appears in the shadow of a hand. Concept for digital crime. Blue toned image.

A Washington, D.C.-based insurance broker was in a good position to get rich off one of the U.S.’s biggest health insurance companies. That is, until the law caught up with him. Now, he’s facing prison time for healthcare fraud and identity theft.

A federal jury recently convicted the man, who used the alias Dean Addem (so much for the alias), of 21 charges related to his scheme to defraud CareFirst BlueCross BlueShield of $2 million, according to a U.S. Justice Department press release on Nov. 8.

The man, 59, was a licensed insurance broker and owner of Benefits Consulting Associates LLC. According to evidence presented during a two-week trial (must have been a lot of evidence), the broker created fictitious employees and altered the birth years of his actual employees to fraudulently obtain lower insurance premiums. He then inflated the rates his company charged to clients and pocketed the difference–more than $2 million. (Makes you wonder about those rising premiums, right?)

The broker was convicted of one count of healthcare fraud, three counts of making false statements related to healthcare, seven counts of mail fraud, six counts of wire fraud, and five counts of identity theft. He is scheduled to be sentenced on March 3, 2020 (Pack a lunch!)

He was indicted in March 2018 following an investigation that included the U.S. Departments of Justice and Health and Human Services, as well as the FBI, and several offices of the District of Columbia. The Justice Department’s Medicare Fraud Strike Force, which also was involved, has charged more than 4,200 defendants, who have collectively billed the Medicare program for nearly $19 billion. (Anyone thinking of defrauding insurance companies should look at the Strike Force’s success rate. Fraudster’s don’t stand a chance.)

Today’s Fraud of the Day is based on the U.S. Justice Department press release, “Insurance Broker Found Guilty of 22 Counts in $2 Million Scheme to Defraud Carefirst Bluecross Blueshield,” on Nov. 8, 2019.

A federal jury found a District of Columbia insurance broker guilty today for his role in a scheme to defraud CareFirst BlueCross BlueShield of more than $2 million.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Jessie K. Liu of the District of Columbia, Acting Assistant Director in Charge Timothy R. Slater of the FBI’s Washington Field Office and Special Agent in Charge Maureen Dixon of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Philadelphia Regional Office made the announcement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.