KC Employee Pleads Guilty to Fraud Scheme to Cheat Health Insurance Program
KANSAS CITY, Mo. – Tammy Dickinson, United States Attorney for the Western District of Missouri, announced that a Kansas City, Mo., employee pleaded guilty in federal court today to his role in a scheme in which hundreds of public employees defrauded their health insurance program of more than $300,000 by falsely claiming to have run marathons and competed in triathlons for cash incentives.
Matt Tholen, 29, of Kansas City, Mo., pleaded guilty before U.S. District Judge Gary A. Fenner to one count of wire fraud.
Tholen, who was employed by the city as an emergency medical technician, received health insurance coverage from Blue Cross/Blue Shield of Kansas City. As an insured, Tholen was eligible to participate in a wellness program offered by Blue Cross called Points to Blue. The program offered gift cards to Tholen and other insureds based upon entries made to the Points to Blue Web site, logging various exercise programs and diet programs completed by the insureds. Every 1,000 points earned translated to one dollar towards a gift card, up to a maximum of $250 annually for each insured. The more strenuous exercises earned more points.
Tholen admitted that he and other employees submitted false entries to the Points to Blue Web site, claiming they completed extremely strenuous activities in order to fraudulently obtain the maximum gift card of $250. To make even more money in this scheme, Tholen admitted, he and others submitted false entries for other employees and their eligible dependents, in exchange for receiving a portion of the fraudulent gift card proceeds.
Tholen made fraudulent Points to Blue submissions on behalf of 62 employees, resulting in 144 gift cards worth a total of $17,600. Among the fraudulent submissions, on Jan. 16, 2011 Tholen submitted an activity entry to Points to Blue stating that 5-year-old “TJ” had completed two marathons and two triathlons.
Under federal statutes, Tholen is subject to a sentence of up to 20 years in federal prison without parole, plus a fine up to $250,000. A sentencing hearing will be scheduled after the completion of a presentence investigation by the United States Probation Office.
This case is being prosecuted by Assistant U.S. Attorney John E. Cowles. It was investigated by the U.S. Postal Inspection Service Task Force, U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and the Overland Park, Kan., Police Department.