State v. Ms. M (DMC No. 15833) – Felony Benefits Fraud/Fraudulent Schemes ($45,000), Felony Theft, and Felony Forgery – Not Charged (Resolved with Civil Settlement) – Genworth Insurance Company Investigated

Ms. M had suffered a stroke, and she had long-term health insurance/disability “reimbursement” coverage. As part of the agreement on the reimbursement, any nurse or health care provider assisting her must be an “employee”. Ms. M had her daughter’s friend (who was a Nurse) in New Mexico claim that she was rendering services in Arizona as an “employee”. Ultimately, $45,000 was reimbursed, and the friend/Nurse kept 12% of this money. The Nurse had been signing off and filing a treatment/reimbursement form in an inappropriate fashion. Ultimately, the Insurance Company Investigator reached out to talk to Ms. M, and that’s when the services of DM Cantor were secured.

Once we became involved, we contacted the Investigator for Genworth Insurance Company. We then spoke with their in-house Counsel, and we were able to arrive at a Civil Settlement for an amount less than $49,000, which would involve no admission of wrongdoing on Ms. M’s part. Once the Agreement was entered and Genworth received their money, they made the decision Not to Seek Prosecution. Had Ms. M been originally Charged, she could have spent Time in Prison. Instead, she has No Criminal History and is leading a productive life post recovery from her stroke.