Health-care fraud a new temptation

As companies drop the benefits, some may not see theft as crime

With more and more employers dumping their health-care benefit plans and the slumping economy stretching pocketbooks to the max, it may seem tempting and harmless for people to simply borrow someone else's health-insurance benefits to get medical care.

Federal prosecutors say using someone else's identity to get health care is fraud, and people who do it face serious criminal penalties.

"People seem to downplay this crime," said U.S. Attorney for Utah Brett Tolman. "The big deal is it's diverting resources to people who aren't paying for them, and that's fraud."

Take the case of Jason Trevor Scharf. Scharf was indicted last August on multiple counts of health-care fraud and identity theft. In accepting a plea deal, Scharf admitted to using stolen personal information to gain access to another man's health-insurance policy so he could receive surgery on his wrist. An associate of Scharf's, Michaele Muree Meier, was also charged with allowing her sister, Leslie Suzanne Zimmerman, to use her health-insurance coverage through her husband to have dental work done.

Scharf faces a maximum of 20 years in prison for fraud and two years for identity theft at his sentencing July 22.

Last May a federal grand jury indicted Trevor D. Bello, who is accused of using the identity of another man to receive about $6,683 in medical care. Given Bello's extensive criminal history, a magistrate judge has ordered him held in federal custody pending the outcome of his case. If convicted, Bello faces up to five years in federal prison for making false statements related to health-care matters and up to 15 years for aggravated identity theft.

But even more prominent figures can run into trouble with the law. The former director of the Housing Authority of Salt Lake City, Rosemary Kappes, found herself charged with health-care fraud and mail fraud after she kept herself on her ex-husband's health-care policy eight years after the two divorced.

The situation came to light during a debate at the Housing Authority over offering health-insurance benefits to employees' domestic partners. Kappes told the FBI that she had divorced her husband for tax purposes and that they continued to live together as "life partners."

Even though Kappes' husband received about $14,000 in medical services, insurance documents showed he had paid some $28,000 in insurance premiums. In essence, the insurance company actually made money over the whole thing. In a plea deal reached with prosecutors, Kappes was sentenced to one day probation.

In instances of health-insurance fraud, Tolman said it's not the insurance companies who are the victim, rather, it's those who are "living within the rules" who must pay the increased medical costs.

---

E-mail: gfattah@desnews.com

Recent comments