Working At a Medicaid Plan

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PostPosted: Fri Sep 26, 2014 2:09 am   Post subject: Working At a Medicaid Plan  

Recently all associates were required to take the annual code of ethics course. At the end of this session, the question is asked if the associate was charged with a felony and the associate responded truthfully; yes. I was recently contacted by the Corporate Compliance Department as a result of my Yes response. I went on to explain that I was charged with Theft by Deception in 1997 and what the charge was pertaining to. No drugs nothing to do with the business something really dumbe and I have no other charges. I work for a Medicare/Medicaid Health Plan and was advised by compliance that they need to research the matter and ensure that the incident is unrelated to the business and also that associates with certain felonies are not permitted to work in a Government Business Division. I manage the processing of grievances and appeals for the Plan. I worked for the organization for a year without incident and a re-review of their resume shows continuous employment at other Medicare/Medicaid plans. I am concerned that I will lose my job although the incident is unrelated to the business and happened 17 years ago. I am almost 50 years old and am a good employee and I would hate to lose my job. I was sought out from another competitor. I was recently advised by compliance that I am not a risk to the organization and that although I was hired by another company before they took us over, they did not ask the appropriate questions during the hiring process. They asked if I was a felon and I said yes. She sais that I need to get a waiver from the insurance commisioner to work. I have never had to do this before in 16 years of working in this industry. Can you give me some guidance.

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PostPosted: Sun Sep 28, 2014 12:12 am   Post subject:   

I have never had to do this before in 16 years of working in this industry. Can you give me some guidance.
Unfortunately Title 18 U.S.C. Section 1033 describes your felony conviction as one that prohibits a person from working in the insurance industry. How you managed to bypass the law that has been in effect since 1994 is a mystery to me.

The Iowa Insurance Division says this about the prohibition:

"Prohibited person" includes but is not limited to, any insurance agency or insurance company employee, agent, solicitor, broker, consultant, third-party administrator, managing general agent, or subcontractor representing an agency or company who engages or participates in the business of insurance as it affects interstate commerce, who has been convicted of any criminal felony involving dishonesty, breach of trust, or a violation of the Act. The determination as to whether the felony falls within the guidelines of dishonesty or breach of trust is made by the federal government.

It is a federal felony to be involved as such without the required consent waiver. The penalty for that is a fine of up to $50,000 and 10 years in a federal penitentiary.

You either need to submit paperwork for the consent waiver or leave your present employment permanently. As it is, you cannot work there until you have a consent waiver.


CA-licensed Life & Disability Analyst. CA Insurance Lic #0596197. Also investigating insurance company abuses, and providing litigation support/expert witness services. Send me your questions, and I'll send you my answers.
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