View this article online: https://www.insurancejournal.com/news/southcentral/2021/04/16/610229.htm
The Louisiana Department of Insurance (LDI) has issued a cease and desist order to a Birmingham, Ala., insurance agency, Senior Care Services LLC, alleging the company uses false or misrepresentative facts and information such as submitting fraudulent applications for insurance policies on behalf of Louisiana consumers.
The LDI also issued a cease and desist order and a fine to Terrance Lamont French, the owner/director of Senior Care Services and a licensed agent in Louisiana. French’s insurance license in Louisiana has been suspended and is slated to be revoked.
The Special Investigation Unit (SIU) at the health insurance company Humana Health Benefit Plan of Louisiana Inc. (Humana) examined Senior Care Services after receiving complaints from policyholders about unauthorized changes to their Medicare Advantage or prescription drug plans, the LDI said.
Humana’s SIU found that several insurance agents used their customers’ health and personal information to access the Medicare online enrollment center and cancel or disenroll the customers from their Medicare Advantage or prescription drug plans without their knowledge. Agents would later re-enroll customers back to the same or a similar plan so that they could become the Agent of Record on the business and receive commissions.
“Committing any sort of fraud is a deplorable act but fraudulently altering the prescription drug plans of a Medicare recipient for profit is an egregious act,” Louisiana Insurance Commissioner Jim Donelon said in a media release. “The tips that started this case came from customers who noticed changes in their policies that they didn’t initiate and called Humana. Attentive customers are the first line of defense against fraud. Their queries helped all of us by revealing these patterns of deception. I encourage any policyholder who notices something that doesn’t make sense to call their insurer or our fraud unit.”
The Louisiana Department of Insurance also issued cease and desist orders and fines to agents Sonja Heard, Bobby Hausley, Kristen Elizabeth Rogers, and David Whitfield. Their licenses have been suspended and are pending revocation.
Another agent, Salzhenitsyn Shumpert, was issued a fine and a license revocation order. Her license had already lapsed at the time of the investigation so there was no need for a cease and desist order.
The agents have the right to appeal these actions to the Division of Administrative Law.