The Louisiana Department of Insurance issued a cease and desist order March 29 to a Birmingham, Alabama, insurance agency, Senior Care Services LLC, for using false or misrepresentative facts and information, such as submitting fraudulent applications for insurance policies on behalf of Louisiana consumers. LDI announced the C&D in a news release on April 15.
The LDI also issued a cease and desist order and a fine to Terrance Lamont French, the owner/director of Senior Care Services and a licensed agent in Louisiana. French’s insurance license in Louisiana has been suspended and is slated to be revoked.
Commissioner of Insurance Jim Donelon fined Senior Care Services $5,000 and fined French $1,000 and ordered them to pay the full amount immediately, according to the order.
The Special Investigation Unit at the health insurance company, Humana Health Benefit Plan of Louisiana Inc., examined Senior Care Services after receiving complaints from policyholders about unauthorized changes to their Medicare Advantage or prescription drug plans. Humana’s SIU found that several insurance agents used their customers’ health and personal information to access the Medicare online enrollment center and cancel or unenroll the customers from their Medicare Advantage or prescription drug plans without their customers’ knowledge. Agents would later re-enroll customers back to the same or a similar plan so that they could become the agent of record on the business and receive commissions.
“Committing any sort of fraud is a deplorable act, but fraudulently altering the prescription drug plans of a Medicare recipient for profit is an egregious act,” said Commissioner of Insurance Jim Donelon. “The tips that started this case came from customers who noticed changes in their policies that they didn’t initiate and called Humana. Attentive customers are the first line of defense against fraud. Their queries helped all of us by revealing these patterns of deception. I encourage any policyholder who notices something that doesn’t make sense to call their insurer or our fraud unit.”
The LDI also issued cease and desist orders and fines to agents Sonja Heard, Bobby Hausley, Kristen Elizabeth Rogers and David Whitfield. Their licenses have been suspended and are pending revocation. Another agent, Salzhenitsyn Shumpert, was issued a fine and license revocation order. Her license had already lapsed at the time of the investigation, so there was no need for a cease and desist order. The agents have the right to appeal these actions to the Division of Administrative Law.
Humana’s SIU discovered through complaints, allegations and interviews of beneficiaries that Senior Care Services and its agents did not meet with the beneficiaries face-to-face for enrollment as Humana requires, according to the C&D order.
One of the cooperating agents confirmed that French and the Senior Care Services management team provided to the agents all of the members’ personal health and other information necessary to enroll the members in the Medicare Advantage program. The agents were told they did not need to meet with members. The agents did not have consent or authority from members before submitting enrollment applications on the members’ behalf. French and his management team instructed the agents to forge the members’ signatures on the enrollment applications within the Humana Agent portal. The agents for Senior Care Services also signed the members’ signatures on the required CMS Scope of Sales Appointment Confirmation Form.
The Humana special investigative unit conducted 55 interviews with Medicare Advantage members enrolled by Senior Care Services agents. Out of the 55, one member remembered meeting with an agent. The other 54 said they did not give any Senior Care Services agent consent or authority to make changes to their plans or enroll them in new or different plans. All of the members who reviewed their signatures on their enrollment applications said the signatures were not theirs.
After receiving a letter from Humana notifying her that she had been removed from her Medicare Advantage Plan and had no medical coverage, a Louisiana Humana member, who had been a Humana member for 20 years, contacted Humana’s Customer Service which eventually led to the Humana SIU’s investigation.
The case remains under investigation by the LDI Division of Fraud and Enforcement. Individuals or businesses with information regarding this case or other insurance related activities of the Senior Care Services staff are encouraged to report these matters by calling 225-342-4956 or 800-259-5300.