United States Attorney James T. Jacks
Northern District of Texas

WEDNESDAY, OCTOBER 20, 2010
http://www.usdoj.gov/usao/txn/

FORMER HEALTH CARE PLAN EMPLOYEE
ADMITS EMBEZZLING NEARLY $50,000 FROM PLAN

AMARILLO, Texas — Debbie Carol Madrid, 57, pleaded guilty yesterday before U.S. District Judge Mary Lou Robinson to one count of theft in connection with a health care benefit program, announced U.S. Attorney James T. Jacks of the Northern District of Texas. Madrid, a resident of Amarillo, faces a maximum statutory sentence of 10 years in prison, a $250,000 fine and restitution. Sentencing is set for December 28, 2010.

According to documents filed, Madrid worked for the IMS Marketing, Inc. Health Benefit Plan (IMS) for approximately 15 years. During the last three years of her employment, she worked as the Eligibility Manager for prescription claims, and had the ability to override the system to get claims paid for participants’ prescription drugs.

Madrid admitted that from March 2004 until June 2007, she submitted false claims for reimbursement for prescription drugs by overriding the system’s documentation requirement. The investigation revealed that she received approximately $46,476 from the Benefit Plan for claims she submitted for prescription drugs she never received. She received payment for 68 of 71 claims she submitted. Madrid accomplishing her theft by 1) submitting fictitious drug claim forms by changing the date on old receipts and submitting as new receipts to receive double payment; and 2) creating false receipts from Texas Tech Pharmacy, where she formerly worked.

In 2007, IMS management discussed the false claims with Madrid. She admitted filing six to eight false claims and agreed to repay the company. Madrid, however, continued to submit false claims.

The case is being investigated by the U.S. Department of Labor Employee Benefits Security Administration. Assistant U.S. Attorney Christy Drake, of the U.S. Attorney’s Office in Amarillo, is prosecuting.

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