A Sumter woman and a Santee woman are among the eight who recently plead guilty to conspiracy to commit mail fraud that bilked Blue Cross Blue Shield out of $368,000.
Lorraine Porcher, 46, of Sumter, and Kimberly Donaldson Broughton, 33, of Santee, reportedly worked with Malentha Robinson-Taylor, 45, of Cordova, to file false insurance claims out of an Orangeburg-based dentist office.
“The dentist realized it,” said Assistant U.S. Attorney Winston David Holliday Jr. “Malentha was out, and he noticed he was getting explanation of benefits for patients he didn’t remember seeing.”
The way the scheme worked is that Robinson-Taylor identified some friends with state insurance through Blue Cross Blue Shield, he said. Because the doctor she worked for is not a network provider for those policies, the individual is expected to pay out of pocket and then receive a check to apply toward that expense.
“But they never had dental services,” Holliday said. “Malentha made it up. So say she said (you) had wisdom teeth removed. You get a $2,000 check in the mail, and you say ‘thank you. Here’s your cut.’”
The claims submitted totaled about $800,000, according to the U.S. Attorney’s Office’s Friday news release.
This is not an unusual scheme, Holliday said.
“Doctors’ offices in particular are susceptible if there are not checks and balances over access to billing,” he said.
The maximum penalty for conspiracy to commit mail fraud is imprisonment for 20 years and/or a fine of $250,000. U.S. District Judge Joseph F. Anderson Jr. of Columbia accepted the guilty pleas and will impose sentences after he has reviewed the pre-sentence reports prepared by the U.S. Probation Office.
“It’s a formula that takes into account factors such as the amount lost and criminal history,” Holliday said. “It’s not as though the judge is sitting there deciding between zero and 20 years. It’s much more academic.”
The others involved in this case are: R.L. Robinson-Taylor, 46, of Cordova; Robert Green, 55, of Orangeburg; Pamela Richardson, 41, of Florence; Latisha Brown, 36, of Lake City; and Cheryl Frazier, 42, of Orangeburg.
Eight Plead Guilty in Fraud Scheme Involving Blue Cross Blue Shield
|U.S. Attorney’s OfficeOctober 25, 2013|
COLUMBIA, SC—United States Attorney Bill Nettles stated today that Malentha Robinson-Taylor, age 45, of Cordova, South Carolina; R. L. Robinson-Taylor, age 46, also of Cordova; Robert Green, age 55, of Orangeburg; Kimberly Donaldson Broughton, age 33, of Santee; Pamela Richardson, age 41, of Florence; Latisha Brown, age 36, of Lake City; Cheryl Frazier, age 42, of Orangeburg; and Lorraine Porcher, age 46, of Sumter, each have entered a guilty plea in federal court in Columbia to conspiracy to commit mail fraud, a violation of 18 U.S.C. § 1349. United States District Judge Joseph F. Anderson, Jr. of Columbia accepted the guilty pleas and will impose their sentences after he has reviewed the presentence reports, which will be prepared by the U.S. Probation Office.
Evidence presented at the change of plea hearing established that Malentha Robinson-Taylor worked for an Orangeburg-based dentist. She and her husband, R. L. Robinson-Taylor, recruited individuals who supplied their Blue Cross Blue Shield policy numbers to them. Ms. Robinson-Taylor then submitted claims as though these individuals had been seen by her dentist employer, even though they had not. When checks were sent directly to the beneficiaries for services that had not been performed, they split the proceeds with the Robinson-Taylors. The other six individuals who pled guilty were all beneficiaries who received checks as part of the fraud scheme. The total claims submitted totaled approximately $800,000. The amount paid was around $368,000.
Mr. Nettles stated the maximum penalty for conspiracy to commit mail fraud is imprisonment for 20 years and/or a fine of $250,000.
The case was investigated by agents of the Federal Bureau of Investigation. Assistant United States Attorney Winston David Holliday, Jr. of Columbia is prosecuting the case.
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Content retrieved from https://archives.fbi.gov/archives/columbia/press-releases/2013/eight-plead-guilty-in-fraud-scheme-involving-blue-cross-blue-shield