Two Florida women who used to work for Aetna are facing criminal charges in a state court in Jacksonville, Florida, over allegations that they submitted at least 42 false supplemental health insurance claims to Aetna and received $1.14 million in unjustified benefits payments.
Law enforcement officials have accused one of the women, Rochell Green, of receiving $408,000 in unjustified benefits from hospital insurance, accident insurance and critical illness insurance plans provided by Aetna.
Breana Ferguson was accused of obtaining $736,000 in unjustified benefits payments.
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Prosecutors charged Green with participating in a scheme to defraud Aetna and filing false and fraudulent insurance claims from 2019 through 2023. Ferguson was charged with participating in a scheme to defraud Aetna and filing fraudulent claims from 2021 through 2023.
Green entered a plea of not guilty Monday at an arraignment at a state court in Duval County, Florida. An arraignment for Ferguson is set for Dec. 2.
Green and Ferguson could not immediately be reached for comment.
Aetna is now part of CVS Health. "Aetna is committed to maintaining the highest standards in our business practices," a CVS representative said. "We take legal allegations seriously and are cooperating with the investigation."
Case details: David Morgan and another detective met Ferguson and her attorney at the attorney's office in April 2024, according to an affidavit by Morgan that was filed with the court.
Ferguson was once married to Green's brother.
"Ferguson provided bank records and testimony that Rochell Green initiated the false insurance claims, and in turn, Ferguson paid Green half of the claim payments," according to the affidavit. "Some of the withdrawals were annotated with 'Rochell Green' and denoted an amount equal to half the payments collected from Aetna."
Green used fake hospital invoices and explanations of benefits to justify her claims, Morgan said.
Morgan reported that he and another detective went to Green's house in August to ask her about allegations that she had defrauded Aflac.
"She invited us into her garage and answered some questions regarding the Aflac claims," Morgan said. "She confirmed she used to work for Aetna. When I showed her the claim forms and fake medical invoices submitted to Aetna, she said she needed to speak with an attorney before answering any more questions. I gave her a business card and left."
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
