NC woman scammed nearly $400K for unneeded treatments – insurer

An insurer is suing a woman who it says doesn’t need the home healthcare for which it has been paying

NC woman scammed nearly $400K for unneeded treatments – insurer

Life & Health

By Ryan Smith

An insurance company is suing a North Carolina woman it claims it paid nearly $400,000 to for unnecessary home healthcare treatments.

New York Life is suing Cynthia McCullough for allegedly scamming $390,000 in insurance payments. According to the insurer, McCullough claimed to suffer from a nervous-system disorder called reflex sympathetic dystrophy. Because of the disorder, she said she needed in-home care to help her bathe, dress and get around, according to a report by North Carolina Lawyer.

New York Life began reimbursing McCullough in 2010, after receiving statements from a home healthcare provider and a doctor that indicated McCullough required at-home care. However, in 2016, the company became suspicious that McCullough was misrepresenting her illness, North Carolina Lawyer reported.

New York Life began conducting surveillance on McCullough. Video recorded by company investigators allegedly shows her lifting heavy objects and carrying them, driving herself, walking normally and bending down to pick up items from the ground. Facebook photos show her playing skee-ball and sliding down a slide. The company also alleged that the caregiver it was paying for wasn’t present at McCullough’s house on many of the days its investigators watched her.

McCullough’s claim was reviewed by two independent doctors. Both said that, in their opinion, she didn’t require the assistance New York Life was paying for, North Carolina Lawyer reported.

“There is no evidence to suggest that the patient requires the assistance of a caregiver for functional activities of everyday living,” Dr. Judy Emmanuel said in court documents filed by New York Life.

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