Plus, lagging Medicaid fraud prevention
Two more former state of Florida employees are among nine more people arrested in a fraudulent insurance claims scheme, DFS arrests two insurance agents for fraudulent behavior, and the Sunshine State has lagged behind other states in stopping Medicaid fraud. It’s all in this week’s Fraud News.
State Claims Fraud: As we reported in our February 9 newsletter, former Department of Financial Services (DFS) employee Briana McCarthy was recently arrested for running a $1.7 million fraudulent property damage claims scheme involving the state Department of Transportation. She is accused of intentionally processing suspicious claims, and splitting the proceeds with the claimants, who were known to her personally. Now a few weeks later, her cohorts are being named and arrested, with nine more arrests, including two former Department of Business and Professional Regulation (DBPR) employees, Brianna Hannan, and Carlotta Hawkins. As the investigation continues, the dragnet is expanding, with other suspects expected to be booked in the coming weeks. DFS Criminal Investigations Division (CID), that made all 10 arrests, is encouraging any other individuals involved to voluntarily come forward.
Insurance Agents Arrested: The CID earlier this month also arrested two insurance agents on fraud, both in Miami-Dade County. Javier Gonzalez Jr. is accused of selling 24 different commercial insurance policies for tow trucks that were fraudulent, along with Aliba Lamas Alvarez, who is not licensed to sell insurance and is in the country illegally. The two allegedly sold policies to the insured owners that contained inaccurate information to satisfy the required insurance limits. A few days later, in an unrelated case, insurance agent Omar Hibbert was arrested for collecting commissions totaling $323,505 on over 100 health insurance policies while using another agent’s information, constituting both identity theft and insurance fraud. Hibbert’s case came to light when the other agent received a call from the IRS, wanting taxes paid on the unreported income, as revealed by the Insurance Journal.
Medicaid fraud, comparative data: As we regularly report, Medicaid fraud is a huge issue in the Sunshine State, especially considering Florida has the largest population of elderly people in the nation. Analyzing comparative data between states from 2022, The Center Square found that Florida is lagging behind in addressing the problem as its Medicaid Fraud Control Unit regained the third most Medicaid dollars at $88.3 million, behind both Texas and California at $219.9 million and $108.5 million, respectively, and barely beating out Louisiana, which has about one-fifth of Florida’s population. Although Florida’s Medicaid Fraud Control Unit reported preventing $236.2 million in fraud in 2024, that was $9 million less than the year before, according to the state Attorney General’s office. From 2020-2025, Florida had as much as $894.5 million in fraud, Center Square claims. In terms of incarcerating Medicaid fraudsters, however, Florida leads the nation. The federal judicial Southern District of Florida in 2024 sentenced 65 people to prison for healthcare fraud – more than the combined numbers from the runner-up’s, the District of New Jersey and Southern District of New York.
LMA Newsletter of 2-23-26
