Insurance claims examiner headed to prison

Insurance claims examiner headed to prison | Insurance Business America

Insurance claims examiner headed to prison

A former lead claims examiner for the Michigan Unemployment Insurance Agency (MUIA) is headed to prison for participating in a $1.5 million pandemic-related insurance scam.

Jermaine Rose has been sentenced to two years in federal prison for his part in the scam, according to Dawn N. Ison, US attorney for the Eastern District of Michigan.

Rose pleaded guilty in April to one count of conspiracy to commit wire fraud related to his participation in a wide-ranging scam designed to fraudulently provide his co-conspirators with pandemic unemployment insurance benefits.

“Corrupt public servants compromise the ability of the government to function effectively and undermine confidence in all public programs,” Ison said. “This prosecution reflects the seriousness with which my office takes corruption and fraud in the public sector, as well as our commitment to prosecuting those who used a national crisis to defraud the public.”

“Jermaine Rose, while employed as a state of Michigan Unemployment Insurance Agency lead claims examiner, abused his authority to allow the payment of more than $920,000 in fraudulent pandemic unemployment assistance claims,” said Irene Lindow, special agent in charge, Chicago Region, for the Department of Labor’s Office of the Inspector General. “Rose exploited his position to release payment on the claims in exchange for kickbacks from his co-conspirators. We will continue to work with our law enforcement and state partners to investigate those who exploit the unemployment insurance system.”

Prosecutors said that in his position as a claims examiner for the MUIA, Rose had electronic access to the agency’s claims database and could use his credentials to approve specific claims.

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Beginning around April 2020, Rose colluded with various people to defraud the MUIA by obtaining unemployment insurance benefits through the submission of bogus claims. Rose’s co-conspirators would electronically submit fraudulent claims to the MUIA in the names of various people – some of whom were victims of identity theft and some of whom were entirely fictitious. The co-conspirators made false statements in the applications to attest to the eligibility of these fictional claimants, and would upload phony documentation to support the claims.

The scammers would then communicate with Rose, either directly or through intermediaries, to identify the claims they had submitted. Rose would then use his access to the MUIA system to approve the claims and release benefits. Most of the time, benefits would be electronically loaded onto debit cards and mailed to addresses controlled by the scammers. Rose was often paid kickbacks – usually between $50 and $150 per claim.

While some of the people who approached Rose had legitimate unemployment insurance claims and worked with him only to speed up the process, many submitted fraudulent claims in bulk, the Justice Department said. In his plea agreement, Rose admitted that he was fully aware that many of the claims he authorized were fraudulent.