A Florida acupuncturist has been charged with scamming Blue Cross Blue Shield of Florida out of nearly $1.5 million.
Jill Jaynes, 56, was arrested last week at her Vero Beach, Fla., office, Absolute Integrated Medicine. She has been charged with racketeering, insurance fraud, engaging in an organized scheme to defraud, patient brokering, and unlawfully waiving copays and deductibles. Jaynes allegedly received more than $5,000 in kickbacks for referring patients to a weight-loss program and illegally waived copays and deductibles totaling more than $100,000. She faces up to 135 years in prison and millions in fines if convicted, according to a report by TCPalm.com.
Jaynes’ lawyer, Brook Butler, said that she intends to enter a not-guilty plea.
According to TCPalm.com, officials in Indian River County, Fla., requested an investigation into Jaynes’ business in January of 2017 because a spike in bills from the clinic was threatening the county’s insurance fund. Investigators spent more than a year reviewing Jaynes’ files and interviewing more than 100 patients.
Authorities allege that between September 2013 and December 2016, Jaynes scammed Blue Cross Blue Shield of Florida out of more than $1.5 million, $1.2 million of which was for county employees, TCPalm.com reported. She allegedly enticed patients to use acupuncture by waiving deductibles and copays. Blue Cross Blue Shield paid 60% of the cost for visits to out-of-network providers like Jaynes; she was required to collect the remaining 40% from the patient.
According to TCPalm.com, Jaynes submitted 32,577 claims to the insurer between January 2010 and May 2017. While Blue Cross Blue Shield paid $4.3 million, Jaynes failed to collect $1.4 million from patients, authorities claimed. When she began collecting copays and deductibles for previously “free” services in 2017, the number of insurance claims dropped more than 95%.
Investigators said that Jaynes had a number of methods for gaming the system. One patient had 259 claims billed to insurance before filling out new patient paperwork. More than 800 appointments deleted from the system were billed anyway. Insurance was billed for 185 claims – a total of more than $22,000 – while the office was closed. And Jaynes allegedly instructed employees to file multiple claims for services from a single visit to help cover the cost of the “free” vitamin supplements she handed out to patients, TCPalm.com reported. A review of patient files showed that less than half of Jaynes’ claims between 2012 and 2016 had documentation, investigators said.
