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Former Blue Cross Blue Shield Employee Arrested For Submitting Hundreds of Fraudulent Medical Claims

3/16/2016

Contact: Ashley Carr
(850) 413-2842
 
JACKSONVILLE, Fla. – Chief Financial Officer Jeff Atwater and the Department of Financial Services’ Division of Insurance Fraud (DIF) today announced the arrest of Frank John Leli. The former Blue Cross Blue Shield of Florida (BCBS) business analyst allegedly defrauded BCBS of nearly $40,000 by submitting more than 350 claims for medical services that never occurred.
 
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.
 
By November 2015, after continuing their own internal investigation, BCBS notified the Division of Insurance Fraud of what they’d 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. This case will be prosecuted by Assistant State Attorney Joe Licandro of the Fourth Judicial Circuit and 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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Chief Financial Officer Jeff Atwater, a statewide elected official, oversees the Department of Financial Services. CFO Atwater’s priorities include fighting financial fraud, abuse and waste in government, reducing government spending and regulatory burdens that chase away businesses, and providing transparency and accountability in spending. Follow the activities of the Department on Facebook (FLDFS) and Twitter (@FLDFS).