As if we haven’t already made in abundantly clear, here on the Allegiant Experts Blog, health care insurance fraud has become somewhat of an epidemic in the United States. This is both sad and ironic considering that our health care system is designed to ward off epidemics, as it were. Nevertheless, stories of physicians and health care workers defrauding the system are delivered via the news on a regular basis.

It should be noted, however, that health care insurance fraud isn’t perpetrating by health care providers alone. Sometimes, people who work in the insurance field themselves are guilty of bilking programs such as Medicare and Medicaid. As Lisa Marie Segarra reports on NorthJersey.com this month, a former union official and an insurance broker – both New Jersey-based – have been charged for conspiring to defraud both Horizon Blue Cross Blue Shield and a union healthcare plan.

66 year-old, Sergio Acosta and 53 year-old, Lawrence Ackerman were both indicted by a federal grand jury earlier this month. Evidently, doctors are not the only ones who have taken advantage of our nation’s health insurance programs. Apparently, this duo has some experience in the field of fraud. As Segarra explains, “Acosta handled the union’s benefits plan as president from 2002 to 2008 and later while serving as a union representative.”

Ackerman, on the other hand, worked as a chief operating officer for such businesses as Atlantic Business Associates, Atlantic Medical Associates, AM Law, Atlantic International Group and Pro-Tech Automotive Services. He used the first two entities as “shell” businesses that were essentially used as imaginary employers. Ackerman pretended that non-employees who required health care coverage were indeed working for the companies so that they could take advantage of their benefit plans.

All in all, Acosta and Ackerman worked together to fraudulently attain coverage for between 700 and 800 ineligible people on the union’s Horizon Blue Cross Blue Shield health care plan. In total, they defrauded the program of $5.6 million. However, even after the insurance company discovered that the claims were fraudulent, Acosta continued to allow the ineligible individuals the ability to remain covered through the union’s self-insured health care plan.

As a result, he was able to bilk another $1 million in insurance money. “Both counts of fraud carry a maximum penalty of 10 years in prison and a $250,000 fine,” reports Segarra, “Acosta and Ackerman will be arraigned at a later date.” We can’t help but be reminded, at the present time however, that health insurance fraud can be committed in many forms and by many different people.

At Allegiant Experts, this is certainly not lost on us. Out team of clinical experts continues to work with attorneys who are trying cases against fraudsters from all walks of life. As we’ve always been, we’re committed to ensuring that justice prevails and, as such, we do all we can to offer our expertise in ways that help for cases against those who commit healthcare fraud to be won.

For more information about our experience, expertise and how we may be able help your case, please don’t hesitate to call us at 407-217-5831 or email us at info@allegiantexperts.com.