Tennessee whistleblower in illegal health insurance scam: "People would call in crying, but we were instructed to tell them that their claims were `in process' and to call back in 30 days"

The Nashville Tennesseean has an extraordinary story today about a company and a number of individuals that our office issued a cease and desist order against back in January.

From the story, by G. Chambers Williams III:

When Lisa Hernandez went to work for health-insurance administrator Smart Data Solutions as a customer-service representative, she thought her job would be to help sick people get their medical bills paid.


But on just her second day, she knew something was horribly amiss.

Hernandez said she had to answer an unending barrage of phone calls from anguished policyholders questioning why no payments had been made on their health claims — some of which had been pending for as long as "four or five years."

"People would call in crying, but we were instructed to tell them that their claims were 'in process' and to call back in 30 days," Hernandez said. "We were told to flat-out lie to people just to get them off the phone."

For most, the medical bills were never paid, she said, adding that "there were boxes of unpaid claims sitting on the floor everywhere — they didn't even have any file cabinets."

The company and its affiliates are under investigation in a number of states, including Washington. Our office believes that dozens of state residents unwittingly bought illegal health insurance products from this network.
More from the Tennessean story:

A companion company, the American Trade Association, marketed the policies, and SDS was the purported benefits administrator; together, the two firms — controlled by Springfield businessman Bart S. Posey — collected as much as $14 million over the past year and a half alone from customers in all 50 states and the District of Columbia, according to the Tennessee Department of Commerce and Insurance.

Stay tuned.