A superintendent from Elwood, Indiana, is facing charges of insurance fraud after police say she used her son`s name to get medical treatment for a sick student who didn`t have... Who's Online | Find Members | Private Messages
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School superintendent charged for using health insurance to help sick student

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24 days ago - Thursday 1/24/19 - 7:09:38 PM EST (GMT-5)
A superintendent from Elwood, Indiana, is facing charges of insurance fraud after police say she used her son's name to get medical treatment for a sick student who didn't have health insurance, CBS affiliate WTTV-TV reports.

Casey Smitherman has been charged with three felonies and a misdemeanor: official misconduct, insurance fraud, insurance application fraud and identity deception. Court records show she was released on $500 bail.

https://www.cbsnews.com/news/indian...
24 days ago - Thursday 1/24/19 - 7:11:18 PM EST (GMT-5)
"As a parent, I know how serious this illness can be if left untreated, and I took him to an emergency clinic," Smitherman said in a statement. "I knew he did not have insurance, and I wanted to do all I could to help him get well." The claim for the clinic visit and the prescription totaled $233, medical records show.

Smitherman told police she was worried about the student after he didn't come to school. She said she had previously bought clothes for him and helped clean his house, according to court documents.

"I know this action was wrong. In the moment, my only concern was for this child's health," Smitherman said.
24 days ago - Thursday 1/24/19 - 7:13:49 PM EST (GMT-5)
Burn our entire insurance system to the ground.
24 days ago - Thursday 1/24/19 - 7:50:26 PM EST (GMT-5)
it f-cking sucks but you just can’t do that in the system we have in place

I can totally appreciate the sentiment behind the action, but she’s screwing herself and her family and potentially that kid she helped with her actions
24 days ago - Thursday 1/24/19 - 8:17:48 PM EST (GMT-5)
She committed insurance fraud for $233? I wonder why she didn't just cover the cost herself. Granted it's not small change, but it wasn't thousands of dollars either...

24 days ago - Thursday 1/24/19 - 8:18:40 PM EST (GMT-5)
On Thursday 1/24/19 - 8:17:48 PM CowDung wrote:
She committed insurance fraud for $233? I wonder why she didn't just cover the cost herself. Granted it's not small change, but it wasn't thousands of dollars either...


$233 is the claim amount. There's no telling what the stuff would have cost without insurance paying their part.
24 days ago - Thursday 1/24/19 - 8:20:29 PM EST (GMT-5)
I thought 'claim amount' referred to the amount paid by insurance...
24 days ago - Thursday 1/24/19 - 8:23:11 PM EST (GMT-5)
I wonder why she just didn’t do a FaceTime doctor and tell them she has the symptoms of strep, got the antibiotics that way?

At least be not so dumb about the fraud.
24 days ago - Thursday 1/24/19 - 8:23:47 PM EST (GMT-5)
...or at least the amount submitted to insurance for payment by the doctor's office/pharmacy.

24 days ago - Thursday 1/24/19 - 8:24:31 PM EST (GMT-5)
It's a little hard to tell what the $233 represents with the way it's written, but insurance companies have negotiated pay rates with clinics, and for prescriptions. In other words, they get to take a (sometimes hefty) deduction from the cost the clinic/hospital/whoever bills. A private-pay patient does not get to take that deduction.

If you have BCBS and their negotiated rate with your doctor who's in-network is $75 for an office visit, that's what they pay. But that doesn't mean that's what the doctor bills. And they have to bill everyone the same amount. So say they bill $100 for that visit, knowing BCBS will take their deduction and pay $75. Maybe Aetna negotiated to pay them $90, or UHC negotiated to pay them $60. But a private-pay (uninsured) person will get the $100 bill and not be able to take a deduction.
24 days ago - Thursday 1/24/19 - 8:26:31 PM EST (GMT-5)
On Thursday 1/24/19 - 8:23:11 PM petitefleur wrote:
I wonder why she just didn’t do a FaceTime doctor and tell them she has the symptoms of strep, got the antibiotics that way? At least be not so dumb about the fraud.


This definitely would have been the smart way to go about this.
24 days ago - Thursday 1/24/19 - 8:28:19 PM EST (GMT-5)
(I kind of get a weird feeling about this story, something doesn’t smell right.)
24 days ago - Thursday 1/24/19 - 8:52:08 PM EST (GMT-5)
I read in an article that she and the kid at first got turned away for not having insurance, there wasn't an option to pay out of pocket?
24 days ago - Thursday 1/24/19 - 8:54:36 PM EST (GMT-5)
How does the kid not have insurance? Medicaid?

Why isn’t she reporting to cps, isn’t she a mandated reporter?
24 days ago - Thursday 1/24/19 - 9:18:10 PM EST (GMT-5)
On Thursday 1/24/19 - 8:54:36 PM petitefleur wrote:
How does the kid not have insurance? Medicaid? Why isn’t she reporting to cps, isn’t she a mandated reporter?


You have to actually apply for Medicaid. It's hard-to-impossible for a kid to do that without help from a parent (because they're a dependent and you have to provide proof of income and all that).

She would be a mandatory reporter afaik, but the article doesn't give much info on the kid's situation, so it's hard to know if there was enough evidence of abuse/neglect for her to have to report.
24 days ago - Thursday 1/24/19 - 9:28:55 PM EST (GMT-5)
I guess I was assuming that the parents would have him on Medicaid, and if not what kind of situation is he in that he isn’t getting the care that he needs with yearly check ups, clothes and a filthy living space.

I’ve always been told if I don’t take my kids to their well child checks, do not provide a clean living space that cps could intervene. I don’t know how true that is.
24 days ago - Thursday 1/24/19 - 9:31:42 PM EST (GMT-5)
I just read that she was afraid of cps putting him in foster care. So, she’s okay with him being in an environment that would bad enough for cps to take him, but doesn’t do anything about it.

Is she a family friend? She has to know him, right?
24 days ago - Thursday 1/24/19 - 9:35:20 PM EST (GMT-5)
I live super near this area. I wonder how they caught on that she was using someone pretending to be her son. She take him to her local urgent care? Someone had to gossip. It’s not a large community.
24 days ago - Thursday 1/24/19 - 9:46:38 PM EST (GMT-5)
On Thursday 1/24/19 - 9:31:42 PM petitefleur wrote:
I just read that she was afraid of cps putting him in foster care. So, she’s okay with him being in an environment that would bad enough for cps to take him, but doesn’t do anything about it.


Yeah I agree, that's sort of a backward way of thinking. I know people think of foster care as horrible, but...it isn't always. I won't say *surely* it has to be better than his situation, because that's not necessarily true, but there ARE good people who take in foster kids.
24 days ago - Thursday 1/24/19 - 9:59:48 PM EST (GMT-5)
I’ve always been told that the goal is to keep the family with their children, so I like to think they can be a wake up call to get parents to get their sht together. If not then it’s a really tough call, but as a mandated reporter it is her job.
24 days ago - Thursday 1/24/19 - 10:05:14 PM EST (GMT-5)
On Thursday 1/24/19 - 9:31:42 PM petitefleur wrote:
I just read that she was afraid of cps putting him in foster care. So, she’s okay with him being in an environment that would bad enough for cps to take him, but doesn’t do anything about it. Is she a family friend? She has to know him, right?

Maybe not. Could just be a more complicated dynamic than we assume.
24 days ago - Thursday 1/24/19 - 10:09:10 PM EST (GMT-5)
On Thursday 1/24/19 - 9:59:48 PM petitefleur wrote:
I’ve always been told that the goal is to keep the family with their children, so I like to think they can be a wake up call to get parents to get their sht together. If not then it’s a really tough call, but as a mandated reporter it is her job.


According to the friends I have who do fostering, that's true...but sometimes the kids get placed temporarily to give the parents a chance to get their sh*t together. I can see how it can be super disruptive to the kids when that's the case. But still...orgs like CASA will try to get involved and like go to homes and help parents learn to do things like keep house and all that, often before fostering becomes an option.
24 days ago - Thursday 1/24/19 - 10:19:30 PM EST (GMT-5)
On Thursday 1/24/19 - 8:52:08 PM NicolesLove wrote:
I read in an article that she and the kid at first got turned away for not having insurance, there wasn't an option to pay out of pocket?

Just to answer this question and not comment on the whole topic: depends on the doctor.
I switched insurance and went back to my old doctor for a visit and they refused to see me (called me and cancelled my upcoming appointment). I asked if I could self-pay and they said no. (No weirdness beforehand, my doctor and I got along great).
Not to say all offices do this but just that it is possible to be turned away.
24 days ago - Thursday 1/24/19 - 10:22:26 PM EST (GMT-5)
Yeah, that's definitely true. Some offices don't want to deal with the hassle of trying to collect directly from patients.
24 days ago - Thursday 1/24/19 - 10:28:31 PM EST (GMT-5)
I meant that as a response to "couldn't they have just paid out of pocket?" Someone said. That i read that they got turned away and there wasn't an option too pay out of pocket and that's why she did the insurance thing, and not just paying out of pocket.

I'm very tired i wasn't very clear

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