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.
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“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.