The owner and operator of a Colorado health plan company pleaded guilty to several charges related to his defrauding and embezzling medical benefit clients of up to $7 million.
Gerald Rising Jr., 60, a Centennial, Colo., resident who owns and operates Rural Health Plans Initiative Administration Co., also based in Centennial, pleaded guilty in U.S. District Court in Denver to one count each of mail fraud, embezzling plan funds and money laundering, the U.S. Attorney’s Office, IRS and Department of Labor Employee Benefits Security Administration announced.
Between 50 to 250 individuals, businesses and governmental agencies lost between $2.5 million to $7 million, authorities said.
Rising was indicted on April 4 and is scheduled to be sentenced Jan. 20, 2012.
From 2003 through November 2010, Rising defrauded individuals, companies, and entities throughout the United States in connection with the delivery of or payment for medical benefits pursuant to health benefit plans and employee welfare plans promoted, sold and administered by Rural Health Plans Initiative Administration Co. (RHPI), a closely held Colorado corporation owned by Rising, records show.
Rising promoted, sold and administered the plans to entities, including school districts in Colorado, Kansas and Oklahoma and would retain part of the plan contributions (about 20%) for administrative costs, and that the remainder was to be held in a designated trust account to pay claims by covered employees and to purchase excess loss or stop-loss insurance through insurance providers like Lloyd’s of London and AIG to cover any claims that exceeded $25,000.00. Stop-Loss insurance is generally a type of insurance that covers medical expenses associated with catastrophic illnesses that exceed specified amounts or limits, proscutors say.
RHPI Captive Insurance Co. is an off-shore corporation, incorporated in Anguilla, British West Indies, by Rising, which maintained the residual fund contributions after the administrative fees were deducted from the premiums paid by employers. Rising served RHPI and RHPIC in several capacities, including as president, director and owner. RHPI maintained a bank account controlled by Rising that was referred to as the contribution trust account, but did not segregate funds in separate accounts for the benefit of each plan.
Rising and employees of RHPI promoted the sale of the RHPI health care benefit plans to business and governmental entities falsely representing that reputable insurance companies like Lloyd’s of London and AIG would provide stop-loss coverage at $25,000.00, when in truth those policies did not provide coverage on claims until they reached approximately $125,000.00. Rising commingled trust funds from various plans in order to pay claims for the aggregated pool of beneficiaries, in violation of the trust agreement; he paid claims on a particular plan using the monies deposited for the benefit of beneficiaries in other plans, in violation of the plan trust agreement.
Rising, in 2008 and 2009, increased his salary in order to siphon monies held by RHPIC for the benefit of plan beneficiaries and in 2009 and 2010, he began to kite checks between various bank accounts he controlled for himself, RHPI and RHPIC, in order to create a false impression as to the financial status of the businesses. Between July and November, 2010, Rising directed employees to falsely represent to various plan beneficiaries and employers that claims for health care services were paid when they were not to deflect concerns about the plans. During the same time, Rising directed employees to send balance sheets to clients which falsely represented the client’s account balances. In late 2010, Rising created bills and invoices that billed and created false indebtedness to the employers for payments RHPIC made for beneficiary and health care provider claims, authorities say.
Rising faces up to 20 years in prison and $250,000 in fines for mail fraud, up to 10 years in prison for theft or embezzlement in connection with health care program, and up to a $250,000 fine, and not more than 10 years in prison and up to a $250,000 fine (or twice the value of the property involved in the transaction) for money laundering.
Colo. health plan owner admits defrauding, embezzling up to 250 clients via IFAwebnews .