A Tallahassee Orthopedic Clinic employee got more than $23,000 in fraudulent health insurance reimbursements when she falsified claims for doctor visits and services that never occurred.
Carol Burns, 40, submitted 18 fraudulent reimbursements on behalf of her and her family dating back to March 2012, court documents said.
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She turned herself in to the Leon County Jail Friday and now faces 56 charges including counterfeit, fraud, forgery and grand theft.
The Florida Department of Financial Services’ Division of Insurance Fraud was tipped off when investigators with Burns’ insurance company, AFLAC, discovered 16 fraudulent claims for services received from Tallahassee Orthopedic Clinic as well as two more for two hospitalizations at Tallahassee Memorial HealthCare.
Burns told investigators she downloaded reimbursement forms from AFLAC’s website and falsely filled them out using medical information she accessed through her work computer. She was able to use doctors’ stamped signatures on the medical claim forms, court documents said.
AFLAC would then cut reimbursement checks made out to Burns.
Burns told DFS Det. Krista Gaston she started making the fraudulent claims because she needed money but continued since it was so “simple,” Gaston told the Democrat Monday. She was able to learn the claims AFLAC paid the most reimbursement on, including doctor visits, fractures, sprains, X-rays, MRIs, medical supplies and emergency room visits, court documents said.
“She kind of learned how to manipulate the system,” Gaston said. “Most of them are for broken bones or for some sort of major medical issue.”
Burns’ access to Tallahassee Orthopedic Clinic information gave her an advantage in which she was able to better legitimize her claims, Gaston said. Burns changed, altered and created new patient files despite the fact her job duties did not require her to view patients’ medical records, court documents said.
She also falsified claims for two TMH visits by changing the names and dates on an old TMH bill. Gaston said Burns’ plan paid her for each day of a hospital stay.
Burns is currently in the Leon County Jail.
