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She’s His Wife?

Healthcare-10
Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

Many families have confusing family dynamics and complicated relationships. The Stephen’s family relationship is a prime example as they are not as they appear on paper. Their familial status is the question of a federal fraud scandal.

Edward Stephen of Baton Rouge, L.A. was recently charged for the frauds he committed while living in Charleston, W.V. Stephen worked for the United States Department of Transportation Federal Highway Administration for the duration of his time in Charleston. Working for the government allowed Stephen to qualify for federal health insurance. (Keep in mind that only immediate family members can be claimed as dependents on federal health care plans.)

Stephen fraudulently enrolled extended family members into his federal healthcare plan from 2005 to 2017. (He knew extended family members were not eligible to be covered by his federal insurance plan but ignored this restriction.) Stephen worked around the regulation by fraudulently claiming his sister as his wife and his niece as his stepchild so that they could be enrolled on his plan. (This sounds like something you’d witness on an episode of Dr. Phil.)

His sister and niece received over $150,000 in fraudulent healthcare benefits during the course of this 12-year period. (Stephen may have just been trying to look out for his sister, but he still intentionally broke the law for over a decade.) While Stephen’s sister has not been charged with a crime, she was willingly complicit and benefitted from his scheme. Stephen admitted to investigators that he lied about his familial status knowing that they were not otherwise eligible to receive coverage.

United States Attorney Mike Stuart of West Virginia issued a warning statement that anyone trying to “cheat the system” would be found and prosecuted. (Stuart kept his promise by prosecuting Stephens for his fraudulent healthcare insurance scheme.)

Stephen recently pleaded guilty to federal health care fraud. He now faces up to 10 years in prison and could be subject to a $250,000 fine. Stephen will also be expected to repay up to $151,660.53 in restitution. (This can be expected to cause a riff in future Thanksgiving family dinners.)

Today’s Fraud of the Day comes from an article, “Man claims sister as wife to get benefits, will serve federal time” published by WOWK on June 10, 2020

CHARLESTON, WV (WOWK) – A former federal employee was sentenced in federal court today after claiming his sister and niece as his wife and step-child, allowing them to obtain over $150,000 worth of fraudulent health benefits.

This scheme lasted from 2005 to 2017 and included several years where the man resided in and worked in Charleston as a federal employee.

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