By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law and Hartley Brooks, Law Clerk, The Health Law Firm
On October 18, 2023, an ex-Navy officer was sentenced to 30 months in prison after he pleaded guilty to conspiracy to commit wire fraud for his role in an insurance fraud scheme. The judge tacked on an extra three years of post-release supervision.
The case is U.S. v. Cote et al., case number 3:18-cr-01674, in the U.S. District Court for the Southern District of California.
The Fraudulent Scheme.
The former Naval officer admitted to conspiring with eight others to defraud the Traumatic Service Members Group Life Insurance Program. This insurance program provides short-term financial support for injured service members.
The former officer allegedly worked closely in the fraud scheme with his then-spouse, who was a Navy nurse, and a Navy doctor.
The scheme consisted of submitting fake or exaggerated injuries to the insurance company to enrich themselves. The ex-Navy officer submitted false claims to the program and encouraged numerous other Navy personnel to submit false claims.
The Navy personnel would submit their medical records to the former officer’s then-wife. As a Naval nurse, she would allegedly falsify the records and the Naval doctor would sign off on the documents. The ex-Navy officer received kickbacks under the guise of a “processing fee.”
The scheme defrauded the insurance program of $2,000,000, and the former Navy officer personally received $400,000, according to the reports on the case. He was sentenced to 30 months for conspiracy to commit wire fraud with three years of supervised release.
What is happening to the others involved in this scheme is not clear at this time. It is doubtful that they will have long, successful Navy careers.
Consult a Health Law Attorney Who Is Familiar with Army, Navy, and Air Force Health Care Professionals and Their Problems.
The attorneys of The Health Law Firm have represented federal physicians, nurses, dentists, and other health professionals in the Army, Navy, and Air Force, active duty and retired, as well as physicians, nurses, and other health professionals working for the Veterans Administration (VA) in the U.S. and around the world. They represent physicians and other health professionals with the Indian Health Service (IHS) and the Public Health Service (PHS). Representation has included disciplinary action, investigations, peer review investigations, clinical privileges actions, fair hearings, National Practitioner Data Bank (NPDB) actions, and appeals.
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Sources:
Correll, Diana Stancey. “Former Navy chief sentenced in $2 million insurance fraud scam.” Navy Times. (19 October 2023) https://www.navytimes.com/news/your-navy/2023/10/19/former-navy-chief-sentenced-in-2-million-insurance-fraud-scam/
Danney, Micah. “Ex-Navy Officer Gets 2.5 Years For $2.5M Insurance Fraud.” Law360. (18 October 2023) https://www.law360.com/health/articles/1734129?nl_pk=0cbd4c0b-c6c8-416a-9e67-b4affa63b102&utm_source=newsletter&utm_medium=email&utm_campaign=health&utm_content=2023-10-19&read_main=1&nlsidx=0&nlaidx=14&detected=1
Lehrfeld, Jonathan. “Former sailor pleads guilty in $2 million insurance fraud scam.” Navy Times. (1 November 2022) https://www.navytimes.com/news/your-navy/2023/10/19/former-navy-chief-sentenced-in-2-million-insurance-fraud-scam/
United States v. Toups No. 3:18-cr-01674 (S.D. Cal October 16, 2023)
About the Authors: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Hartley Brooks is a Law Clerk at The Health Law Firm. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.
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