Two Aetna employees were arrested for allegedly orchestrating a $1.1 million fraud scheme, according to a Nov. 15 news release from Florida CFO Jimmy Patronis.
According to the release, Rochell Green and Breana Ferguson were both employees familiar with the claims process for hospital, accident and critical voluntary supplemental plans. Ms. Green and Ms. Ferguson both enrolled in these plans, and presented 42 false insurance claims for payouts between 2019 and 2023, Mr. Patronis alleged.
The two Aetna employees allegedly used fake medical invoices and explanations of benefits for procedures that did not occur to support their claims, according to the release. Ms. Green began the scheme in 2019 and later introduced Ms. Ferguson to it in exchange for half of the fraudulent claim payments she received, Mr. Patronis alleged.
Ms. Green allegedly received more than $408,000 in fraudulent claim payments, and Ms. Ferguson allegedly received more than $736,000.
The two women were charged with one count of false insurance claims and one count of scheme to defraud. The two face up to 30 years in prison for each count, if convicted.
"Aetna is committed to maintaining the highest standards in our business practices," an Aetna spokesperson said in a statement shared with Becker's. "We take legal allegations seriously and are cooperating with the investigation."