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Sherner v. National Loss Control Services Corp.11/15/2005
w, initially provided the care. She submitted time sheets and a bill totaling $9,000 for services in 1996. However, an investigator for Intermountain conducted surveillance and found that Tracey was not actually with Peter at all times for which she billed. Intermountain filed a workers' compensation petition against Tracey alleging fraud. The dispute was settled in May of 1997, and Intermountain informed the Sherners, through their attorney, that Peter's home health care must be provided by a properly certified and licensed home health care aide and not by a family member.
In November of 1996, the Sherners chose their neighbor Bernice Corcoran (Bernice) to provide home health care services. Bernice was not a certified home health care aide when she started, but attended classes at a local nursing home and earned her certification while providing services for Peter.
On November 28, 1997, the Governor's Fraud Hot Line received an anonymous call that Bernice had been submitting time sheets claiming to have provided services to Peter which she had not provided. Intermountain was notified and tried to verify with Peter's doctor whether he was still in need of home care. The doctor Intermountain had previously consulted was no longer providing Peter's health care.
In January of 1998, Crawford replaced Intermountain as National's local claims adjuster. In January of 1999, Crawford adjuster Andersen noted discrepancies in Bernice's billing statements. Crawford requested evaluation of Peter by his treating physician, who verified that Peter's maximum of nine hours a day of home health care was necessary and appropriate.
Crawford then hired a private investigator from BCI, Inc., to observe Bernice and determine if she was actually providing care to Peter at the times claimed. BCI's surveillance revealed that Bernice was not with Peter on some days for which she billed. Crawford also interviewed both Peter and Bernice, and confirmed that Bernice was not providing all the services for which she billed. Accordingly, Bernice's services were terminated on November 17, 1999.
National then referred its concerns regarding Bernice's services to the State Auditor--the ex officio insurance commissioner in Montana--whose office conducted its own investigation into the matter. In response to a written request, National and Crawford each provided the State Auditor with copies of all of the documents each possessed relating to Peter's workers' compensation claims, and otherwise cooperated with the State Auditor's investigation. The State Auditor also obtained payroll records from Saint Vincent Hospital, where Bernice worked part-time, and discovered that Bernice was working there during some of the times she claimed to have been providing home care to Peter. Bernice later admitted to having "double billed" her time.
On January 29, 2001, with the State Auditor's attorney--who had been specially deputized as a deputy county attorney--serving as the prosecutor, the Yellowstone County Attorney filed criminal charges against Peter and Bernice. The Information filed on behalf of the State of Montana charged Peter with felony theft by common scheme because he signed the fraudulent bills Bernice submitted.
During discovery, Bernice admitted she had "subcontracted" with the Sherners' son, Trevor, to pay him $400 a month to provide some of his father's home health care. Neither Bernice nor the Sherners ever reported this arrangement to anyone at Conoco, Intermountain or Crawford. Trevor kept no records of when he provided services, and he was not a certified home health care provider. Deborah Sherner admitted that, despite her knowledge that famil
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