Former BCBS of Florida employee defrauds insurer of $40k

An ex-Blue Cross Blue Shield of Florida business analyst has been arrested after submitting hundreds of false medical service claims, according to The Florida Times-Union.

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Frank John Leli defrauded BCBS of Florida of almost $40,000 after submitting more than 350 insurance claims, 12 of which were found to be justifiable.

After he filed a large number of medical claims around August 2014, BCBS of Florida investigated Mr. Leli’s behavior. Twenty-seven claims of his claims were filed to a marriage family therapist, but the therapist only verified 12 of the claims, according to WJXT News4Jax.

The Florida Department of Financial Services’ Division of Insurance Fraud further looked into the situation last November and found Mr. Leli had filed hundreds of claims to two chiropractors in Georgia, neither of whom confirmed he had ever been a patient.

Mr. Leli was charged with grand theft, insurance fraud and organized scheme to defraud. Bail was set at $150,000, and he bonded out later during the day.

He could face 15 years in prison if he’s convicted.

More articles on payer issues:
AMA, physicians to Florida AG: Stop the Humana-Aetna merger
Could Humana’s past predict the effects of its merger with Aetna?
CMS fines Humana $3.1M for Medicare violations

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