Opioid treatment, workers’ comp among other frauds of note
The Federal Trade Commission has shut-down a South Florida-based operation that it says was marketing discount health programs disguised as Affordable Care Act-qualified health insurance plans. Also in South Florida, the owner of an opioid treatment center is under arrest for insurance fraud, plus the crackdown on unlicensed contractors continues in Pinellas County – all in this week’s fraud alert.
The Federal Trade Commission (FTC) has targeted Steven J. Dorfman of Miami and his Hollywood-based operation that conducted business as Simple Health Plans LLC, Health Benefits One LLC, and 16 other names. According to FTC documents, consumers who enrolled reported paying as much as $500 per month for what was actually a medical discount program or extremely limited benefit program that did not deliver the promised benefits and effectively left consumers uninsured. FTC agents posed as customers to call and confirm the “scam”.
The FTC alleges that as a result, tens of thousands of consumers who thought they had purchased comprehensive health insurance found themselves uninsured, some saddled with substantial medical expenses that they assumed would be covered by what was supposed to be health insurance from Simple Health. Dorfman meanwhile took the millions of dollars of proceeds for “lavish spending for himself” which included more than $1 million in jewelry and luxury cars, says the FTC.
Meanwhile, up the road in Boynton Beach, Florida Department of Financial Services insurance fraud investigators have nabbed the owner of The Hope Center of Recovery, an opioid treatment facility. James Durkin was charged with two counts of organized scheme to defraud for allegedly submitting more than $104,000 in fraudulent insurance billing to Cigna and United Health Care for addiction recovery treatments that never happened.
On the other coast in Pinellas County, the Sheriff’s Department is continuing its very successful sting at catching unlicensed contractors, who in many cases, aren’t carrying required workers’ compensation insurance either. The latest arrests involve 35 people who answered a sheriff’s department ad soliciting repair work at a fake storefront.
When the contractors showed up, police found most of them didn’t have contractor licenses and many of those didn’t have workers’ comp insurance. Pinellas County Sheriff Bob Gualtieri was quoted in published reports as saying “We’re setting up these undercover operations and we make the phone calls and they come. It really is too easy. When we start seeing the numbers go down and we start seeing people show up who are licensed, then we’ll know we are making a difference and we’ve made an impact in this.”
The Sheriff’s Department has arrested 110 unlicensed contractors on more than 240 criminal charges since the undercover sting, appropriately titled “Operation Nailed” began in August of 2017.