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CA Department of Insurance

Social Media post leads to guilty plea in healthcare fraud case

News: 2014 Press Release

For Release: May 12, 2014
Media Calls Only: 916-492-3566
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Social Media post leads to guilty plea in healthcare fraud case

ANAHEIM, Calif. – Maria Lemusu, 50, plead guilty last week to healthcare fraud. Lemusu falsified the dates on her disability statement leading to her insurer making her loan payments. The fraud was later revealed through one of Lemusu's Facebook posts. Lemusu has been placed on probation for three years, and was required to pay restitution in the amount of $10,896.

"This case is a great example that no matter how large or small the dollar amount of fraud is, you will get caught and pay a price," said Insurance Commissioner Dave Jones. "Anyone who thinks to cheat their insurer should know that my department is committed to working with our law enforcement partners and the industry to put a stop to fraud."

Lemusu had taken out three Certificates of Insurance to cover her credit loans in the event she became disabled and was unable to work. Credit disability is a health insurance policy that makes payments to a lender if the policyholder becomes sick or disabled and is unable to work. In August of 2011 Lemusu filed a claim with her insurer. She received confirmation letters from her insurer that her credit payments were being made while she remained on disability. Lemusu's filed supplemental documents stating that she was on disability from August 3, 2011 through March 18, 2013.

It was discovered through a Facebook post by Lemusu that she had returned to work, as she wrote about the view from her desk at the office. Upon inquiry, Lemusu's employer provided information that showed Lemusu had returned to work September 26, 2011 and continued working through June 4, 2012 before going on medical leave again.

The California Department of Insurance, established in 1868, is the largest consumer protection agency in California. Insurers collect $310 billion in premiums annually in California. Since 2011 the California Department of Insurance received more than 1,000,000 calls from consumers and helped recover over $469 million in claims and premiums. Please visit the Department of Insurance website at Non-media inquiries should be directed to the Consumer Hotline at 800.927.4357. Telecommunications Devices for the Deaf (TDD), please dial 800.482.4833.

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