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2 Charged With Medicare Conspiracy

September 13, 2002

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ST. LOUIS (AP) _ Federal grand jurors have accused two former General American Life Insurance Co. workers of conspiring to falsify Medicare billing information, nearly three months after the MetLife Inc. subsidiary agreed to pay $76 million in a Medicare fraud settlement.

U.S. Attorney Ray Gruender said Thursday’s indictment of Carol Messina and Mary Wimbley ``clearly shows that the government will hold criminally responsible those individuals who engage in corporate fraud _ even if the corporation pays $76 million in restitution and penalties.″

When the civil settlement was announced in June, the government said General American failed to process claims properly, failed to report errors identified in a quality-assurance process and deleted claims selected for review by the government that the company believed would adversely affect their error rate, replacing them with claims handled correctly.

Federal prosecutors alleged the concealment spanned more than a decade until 1998, when St. Louis-based General American stopped participating in the Medicare program.

Gruender has said that during the alleged fraud General American’s nationwide rating from 38th to second, with the favorable ranking helping the carrier retain its Medicare contract and compete for additional ones nationwide.

The deception led to more than $17 million in estimated losses to the Medicare trust fund, the government has said.

General American, acquired by New York-based insurance giant MetLife Inc. in 2000, did not admit wrongdoing in the settlement.

Messina, 59, and Wimbley, 56, are accused of knowingly providing false information to the Centers for Medicare and Medicaid Services, the federal agency that audits carriers.

The original allegations were brought in a whistleblower case by former General American manager Harry Riggs and his wife Nancy, a former claims processor with the company. The couple received $14.4 million of the $76 million June settlement.

Messina, General American’s former Medicare director, and Wimbley, an ex-General American Medicare manager who reported to Messina, each are accused of one felony count of conspiring to falsify and conceal information from federal auditors. Messina also faces two felony counts of making a false statement to a federal agency. Wimbley is accused of one such count.

Each count carries a possible five years in prison and $250,000 in fines.

A woman who answered the telephone Friday at Messina’s home said she was unavailable. A message left at Wimbley’s St. Louis home was not immediately returned.

MetLife spokesman John Calagna said Friday that Messina and Wimbley weren’t with General American when MetLife bought it in 2000. Calagna said he had no specifics about when or why Messina and Wimbley left the company.

``We settled with the government civilly in June, and that basically concluded our involvement in the case,″ Calagna said. ``As prosecutors were looking at these two individuals, General American was fully cooperating with the investigation. If there’s any further investigative matters, we will continue to cooperate.″

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On the Net:

MetLife Inc., http://www.metlife.com

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