Ex-Blue Cross Blue Shield employee charged with fraud
JACKSONVILLE, Fla. – A former Blue Cross Blue Shield of Florida business analyst has been arrested for allegedly defrauding BCBS of nearly $40,000.
Frank John Leli submitted more than 350 claims for medical services that never occurred, according to state officials.
In August 2014, Blue Cross Blue Shield became suspicious of Leli’s activities after recognizing a pattern in which he submitted multiple medical claims on his own behalf during a short period of time. At first glance, 27 claims were found to have been filed related to alleged treatments by a Jacksonville-based marriage and family therapist. BCBS contacted the therapist, who verified only 12 of the 27 claims. The remaining claims were for medical treatments that never took place, officials said.
By November 2015, after continuing its own internal investigation, BCBS notified the Division of Insurance Fraud of what it had discovered. With BCBS’s assistance, DIF’s investigation uncovered hundreds of additional claims Leli filed related to alleged treatments by two separate Georgia-based chiropractors. Both chiropractors stated that Leli was neither a current patient nor had he ever been a patient at their practices.
In total, Leli submitted more than 350 claims, and only 12 were found to be legitimate. As a result of those claims, Leli fraudulently collected nearly $40,000 in insurance benefits.
Leli was arrested and booked into the Duval County Jail with bond set at $150,000. His charges include insurance fraud, grand theft and an organized scheme to defraud.
If convicted, Leli faces up to 15 years in prison.
The Georgia Bureau of Investigations and Blue Cross Blue Shield both played a vital role in this investigation.
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