An internal fraud scheme has cost a Florida insurance company more than $1.1 million. According to a statement from the Florida Department of Financial Services (DFS), two employees of Aetna, Rochell Green and Breana Ferguson, have been arrested for orchestrating a large-scale insurance fraud operation.
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Details of the Fraudulent Scheme
Investigators revealed that Green and Ferguson, based in the Jacksonville area, exploited their knowledge of insurance claim processing to execute their scheme. They were familiar with how hospital coverage, accident insurance, and voluntary supplemental plans operated.
Both women enrolled in these plans and submitted fabricated documents to support claims for medical procedures that never occurred and for non-existent patients. Florida CFO Jimmy Patronis said: “It’s amazing the lengths bad actors will go to commit fraud and scam the system for a quick buck. I commend our insurance fraud detectives for arresting these fraudsters and putting them behind bars where they belong.”
The Scheme Began in 2019
According to DFS, the scheme started in 2019 when Rochell Green, 40, began submitting false claims. She later invited Breana Ferguson, 34, to join her in the operation, splitting the proceeds from fraudulent claim payments.
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Green collected over $408,000, while Ferguson’s fabricated claims generated more than $736,000. In total, the fraud caused losses exceeding $1.1 million for Aetna.
Legal Consequences
Green was arrested on October 25, while Ferguson was taken into custody on November 8. Both were booked into the Duval County Jail but were later released on bond.
Records from the Duval County Sheriff’s Office show that Green had previously been charged in 2012 for attempting to cash a worthless check. This time, the charges are far more severe, and both women now face significant legal consequences.
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Authorities Issue Warnings
This case serves as a strong reminder of the sophisticated and bold nature of insurance fraud schemes. Jimmy Patronis emphasized: “Actions like these not only cause financial losses but also undermine public trust in the insurance system. We will continue to work tirelessly to ensure these criminals are held accountable.”
The Florida Department of Financial Services has also urged insurance companies to enhance their vigilance by implementing stricter verification processes to prevent similar schemes in the future.
Impact of the Fraud
This case highlights more than just financial losses; it underscores a breach of ethical conduct within the insurance industry. When employees who understand internal processes exploit their positions for personal gain, the damage extends beyond monetary costs—it erodes public trust in these companies.
Additionally, this incident emphasizes the need for robust internal training and oversight within organizations. Experts suggest that insurance companies must invest more in fraud detection technologies and foster a culture of integrity among employees.
Conclusion
The fraudulent activities of Rochell Green and Breana Ferguson not only cost Aetna more than $1.1 million but also serve as a stark warning for the insurance industry about the importance of closely monitoring internal operations.
Thanks to swift action by the Florida Department of Financial Services, these criminals were brought to justice. However, this case also highlights the ongoing need for companies to adopt stronger safeguards against internal threats. As Green and Ferguson face legal repercussions, their actions serve as a cautionary tale for organizations everywhere.
