Jacksonville Insurance Employees Arrested for $1.14M Fraud Scheme

Two healthcare employees in Jacksonville, Florida, have been arrested for submitting 42 fraudulent insurance claims, amassing $1.14 million in illegal payouts between 2019 and 2023. The alleged scheme involved falsified medical invoices and benefit explanations for procedures that never occurred. According to the Florida Department of Financial Services (DFS) and its Criminal Investigations Division (CID), one employee fraudulently collected over $408,000, while the other amassed more than $736,000.

Investigators uncovered that the employees, using their expertise in claims processing, exploited hospital and supplemental insurance plans. One employee allegedly introduced the other to the scheme, sharing a portion of the illicit proceeds. The arrests followed a thorough DFS investigation initiated in February 2024, resulting in charges of false insurance claims and a scheme to defraud.

Florida’s Chief Financial Officer Jimmy Patronis emphasized the broader impact of such fraud, which drives up insurance rates for residents. He commended investigators for their diligence and encouraged the public to report suspicious activity. Both individuals face up to 30 years in prison if convicted.