Shari Spencer, Health Benefits Theft, Ohio 2010

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Youngstown Woman Sentenced for Health Benefits Theft

A Youngstown woman has been sentenced to 3 1/2 years in prison and ordered to pay nearly $55,000 in restitution for using false identities to defraud health benefit plans, United States Attorney Steven M. Dettelbach said.

Shari Spencer, 42, previously pleaded guilty to three counts: theft from a health-benefit program, aggravated identity theft, and making false statements.

Spencer, who was employed by Professional Benefits Administrators (PBA) in various capacities from 2000 until she left in September 2010, had access to the names, addresses, social security numbers, employee numbers, and other personal identification information of Northern Ohio Medical Specialists (NOMS) employees.

She also had access to the PBA claims system and to information relating to the NOMS Health Benefit Plan Trust Account. Spencer used this information to submit false claims to TPAC, an insurance carrier, for stop-loss payments, resulting in a loss of nearly $55,000.

The court documents revealed that PBA had a number of clients with whom it contracted to provide third-party administration services in relation to the health care benefit plans that the clients sponsored for their employees. Those clients included NOMS and Community Health Care, Inc. (CHC).

NOMS was the sponsor of the Northern Ohio Medical Specialists Employee Health Benefit Plan – HSA Plan, a self-funded health care benefit plan for the benefit of NOMS’ employees. PBA was the third-party administrator for the NOMS Health Benefit Plan, responsible for processing and adjudicating the health benefit claims of NOMS employees.

The court documents outlined the details of Spencer’s crimes, which included using false identities to defraud health benefit plans, aggravated identity theft, and making false statements. Spencer’s sentence reflects the severity of her crimes and the significant financial loss she caused to her former employer and clients.

United States Attorney Steven M. Dettelbach said, ‘Spencer’s sentence sends a strong message that using false identities to defraud health benefit plans will not be tolerated.’

RELATED: Damon Perry Sentenced