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Medicare Fraud Returns Guilty Pleas

October 3, 2002

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ST. LOUIS (AP) _ Two former General American Life Insurance Co. workers pleaded guilty to falsifying billing information in a scheme that cost Medicare more than $17 million.

The pleas Wednesday by Carl Messina, 59, and Mary Wimbley, 56, came three months after the MetLife Inc. subsidiary agreed to pay $76 million in a Medicare fraud settlement.

The settlement included payments to the government and two whistleblowers who reported the fraud.

The government said in the June settlement that General American failed to report errors and deleted claims tapped for government review, replacing them with correctly handled claims to minimize its error rate.

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

During the alleged fraud, the government said, General American’s nationwide rating as a carrier shot up from 38th to second, helping it 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 said.

Messina, General American’s former Medicare director, and Wimbley, a former manager, were accused of knowingly providing false information to the Centers for Medicare and Medicaid Services, the federal agency that audits carriers.

They each pleaded guilty to one felony count of conspiring to falsify and conceal information from federal auditors.

They face up to five years in prison and $250,000 in fines when sentenced Dec. 20.

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

A woman who answered the telephone at Messina’s home in suburban St. Louis said Messina would not comment. When reached Wednesday night at her St. Louis home, Wimbley directed media questions to her attorney, who did not return telephone messages.


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