A former Aetna employee has been sentenced to five years in prison in Ohio over his involvement in several fraudulent claims schemes.
The individual, Justin Mack, pleaded guilty to 13 felony counts of insurance fraud, telecommunications fraud, tampering with records, identity fraud, forgery, and attempted theft, according to a Nov. 26 news release from the Ohio Department of Insurance. He has also been ordered to pay $229,000 in restitution.
The sentencing comes shortly after two other Aetna employees were arrested in Florida in November for allegedly orchestrating a $1.1 million fraud scheme involving the submission of 42 false claims between 2019 and 2023.
In Ohio, an investigation uncovered Mr. Mack's pattern of submitting altered documents, falsified claims, and identity theft to fraudulently secure payouts from multiple insurers, including Aetna.
Between November 2022 and October 2023, Mr. Mack filed 21 fraudulent claims while employed at Aetna, receiving more than $162,000 for false hospitalizations, accidents, and a fabricated cancer diagnosis. Additionally, he submitted fraudulent claims totaling over $67,000 to property and pet insurers.
"Aetna is committed to maintaining the highest standards in our business practices," a spokesperson for the insurer told Becker's. "We take legal allegations seriously and cooperated fully with the Ohio Department of Insurance's investigation into Mr. Mack."