A California Department of Insurance investigation resulted in the conviction of a Los Angeles woman to two years in state prison and fines of $160,000 for her part in an insurance fraud scam. Kathleen C. Ridgway, 37, was sentenced in Los Angeles Superior Court on April 25. The Los Angeles County District Attorney’s Office prosecuted the case.
CDI investigators received information from Aetna U.S. Healthcare noting that Ridgway, the claimant, turned in fradulent reimbursement claims supported by false medical expense paperwork and receipts for prescriptions she had apparently received. Following an Aetna investigation, it was discovered that those reimbursement claims were to be for prescriptions which Ridgway did not actually purchase or pay for. Ridgway received more than $170,000 in reimbursements prior to the fraud being discovered.
A CDI branch investigation showed that Ridgway faked prescription claim paperwork to Aetna U.S. Healthcare for three years, resulting in more than $170,000 worth of invalid prescription claims.
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