Dive Brief:
- A former Capital BlueCross health claims examiner, and four other people, have been indicted over false insurance claims amounting to $292,000 filed in 2012 and 2013.
- U.S. Attorney Peter Smith told the media employee Chireta Dantzler took personal information from four individuals to file the fraudulent claims.
- Prosecutors allege Dantzler is the "mastermind" of the scheme. Dantzler was charged with three separate counts of healthcare fraud in relation to claims submitted in 2013.
Dive Insight:
Capital BlueCross discovered Dantzler's activity and dismissed her in 2014. It then reported the fraud to law enforcement.
Dantzler served as a health claims examiner for the company in the Harrisburg, Pennsylvania area and submitted claims for ambulance services that were never rendered, Central Penn Business Journal reports.
According to the U.S. Attorney’s Office, Dantzler's intent was to submit a total of $400,000 in false claims. The claims were filed with Capital BlueCross, CareFirst, and Excellus Health Plan - all members of the Blue Cross Blue Shield Association.
The indictment against Dantzler alleges 30 fraudulent claims were submitted from June 2012 to November 2013.
"Insurance fraud should not be tolerated as it impacts every consumer," Capital BlueCross spokeswoman Kirsten Page said in a prepared statement.
"We immediately terminated the employee upon discovering the inappropriate activity, and reported it to law enforcement," Page added. "We fully cooperated every step of the way. We cannot comment further as it is a legal matter and an ongoing criminal case."