BEFORE THE HEARING BOARD
ILLINOIS ATTORNEY REGISTRATION
In the Matter of:
TRACY H. WOLFE,
Commission No. 2017PR00094
FILED --- August 30, 2017
Jerome Larkin, Administrator of the Attorney Registration and Disciplinary Commission, by his attorney, Gina M. Abbatemarco, pursuant to Supreme Court Rule 753(b), complains of Respondent, Tracy H. Wolfe, who was licensed to practice law in the State of Illinois on May 9, 2002, and alleges that Respondent has engaged in the following conduct which subjects Respondent to discipline pursuant to Supreme Court Rule 770:
(Dishonesty and insurance fraud in receiving health benefits)
1. At all times alleged in this complaint, there was a criminal statute in Illinois, 720 ILCS 5/17-10.5(a)(1) which provided in part that a person committed insurance fraud by:
knowingly obtain[ing], attempt[ing] to obtain, or caus[ing] to be obtained, by deception, control over the property of an insurance company or self-insured entity by the making of a false claim or by causing a false claim to be made on any policy of insurance issued by an insurance company or by the making of a false claim or by causing a false claim to be made to a self-insured entity, intending to deprive an insurance company or self-insured entity permanently of the use and benefit of that property.
2. Section 720 ILCS 5/17-0.5, identified a "false claim" as:
any statement made to any insurer, purported insurer, servicing corporation, insurance broker, or insurance agent, or any agent or employee of one of those entities, and made as part of, or in support of, a claim for payment or other benefit under a policy of insurance, or as part of, or in support of an application for the issuance of, or the rating of, any insurance policy, when the statement does any of the following:
(1) Contains any false, incomplete, or misleading information concerning any fact or thing material to the claim.
(2) Conceals (i) the occurrence of an event that is material to any person's initial or continued right or entitlement to any insurance benefit or payment or (ii) the amount of any benefit or payment to which the person is entitled.
3. In 2009, Respondent left her position as in-house counsel for a commercial real estate company and began practicing law as a sole practitioner.
4. Between 2009 and October 2010, Respondent decided that she wanted to have a second child and she began investigating obtaining health care insurance coverage which would cover her pregnancy and delivery. During this time, Respondent learned that the individual medical insurance policies she had investigated would not cover another pregnancy and delivery unless Respondent waited 12 months after the coverage commenced to become pregnant.
5. Sometime between 2009 and October 2010, Respondent discussed with her father, Daniel Michael ("Michael"), that Respondent could not obtain medical coverage for a pregnancy and delivery unless she was willing to wait another 12 months to become pregnant. At that time, Michael was the principal in Horizon Realty Group ("HRG"), which was an apartment leasing and property management company in Chicago. Michael offered to include Respondent and her dependents under HRG's group insurance policy, which would not require Respondent to wait another 12 months to become pregnant.
6. At all times between 2010 and 2014, Respondent did not maintain individual medical or dental insurance coverage for herself, her husband and her child(ren) through her law practice, nor did her husband's employer provide such insurance for Respondent or their child(ren).
7. On January 11, 2011, at Michael's direction, HRG employee Robert Berman sent Respondent a fax enclosing an employee application for benefits ("EAB") under HRG's existing group health and dental insurance policies with Blue Cross Blue Shield ("BCBS"). Respondent knew that she would be required to complete the EAB and return it to HRG so that HRG could submit it to BCBS in order to enroll Respondent and her dependents in HRG's group health and dental insurance plan.
8. At no time between 2009 and 2016 was Respondent an employee of HRG, nor did she perform any services for HRG or otherwise work at HRG to become eligible for coverage under HRG's group health and dental insurance policies.
9. On January 11, 2011, Respondent completed parts of the EAB. In section 1 entitled "Employee Information" Respondent wrote her name next to the line that asked for "employee name" and added her social security number in the section asking for "employee social security number."
10. Respondent's statements on the EAB application that she was an employee of HRG were false.
11. Respondent knew at the time she made such statements that they were false because she knew she was not an employee of HRG.
12. In the section entitled "Employment status" Respondent checked the box "active employee."
13. Respondent's statement on the EAB that she was an active employee of HRG was false.
14. Respondent knew at the time she made the statement referred to in paragraph 12, above, that it was false because she knew she was not an employee of HRG.
15. In Section 5 entitled "Family Coverage Information" Respondent listed her husband and daughter as her dependents for coverage purposes.
16. At the bottom of the second page of the EAB, in Section 7 entitled "Application for Coverage" Respondent certified that: "I apply for coverage as indicated above, for which I am or may be eligible under the agreement with Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company (providing hospital, medical, dental and health maintenance coverage) and/or Fort Dearborn Life Insurance Company (providing life and disability insurance) which are herein exclusively called the Company. I have read the above statements and represent that they are true and complete to the best of my knowledge."
17. Underneath Section 7 and after completing the required sections of the EAB form, Respondent placed her signature on the line where it stated "Employee signature" and dated the form "1/15/11."
18. Respondent's assertion that the information contained in the EAB that she completed was true and complete was false.
19. At the time she signed the EAB, Respondent knew her certification that the information contained in the EAB she completed was true and complete was false because she knew she was not an employee of HRG.
20. On January 15, 2011, Respondent returned the completed EAB to HRG.
21. On January 18, 2011, HRG sent Respondent's completed signed and dated EAB to BCBS so that BCBS would enroll Respondent in HRG's group health insurance plan.
22. Between February 2011 and January 2016, Respondent presented claims to Blue Cross and Blue Shield under the HRG's policy and obtained $111,032.49 in insurance benefits for herself and her dependents, to which they would not otherwise have been entitled.
23. By reason of the conduct described above, Respondent has engaged in the following misconduct:
conduct involving dishonesty, fraud, deceit, or misrepresentation, by conduct including falsely claiming on the EAB that she was an employee of HRG and thereby entitled to benefits when she knew she was not an employee, in order to obtain insurance benefits to which she would not otherwise have been entitled, submitting insurance claims to BCBS for payment when Respondent knew she was not entitled to those benefits, in violation of Rule 8.4(c) of the Illinois Rules of Professional Conduct (2010); and
engaging in a criminal act that reflects adversely on her honesty, trustworthiness, or fitness as a lawyer, by committing insurance fraud by submitting false claims when she was not entitled to insurance coverage as an employee of HRG, in violation of 720 ILCS 5/17-10.5(a)(1), in violation of Rule 8.4(b) of the Illinois Rules of Professional Conduct (2010).
WHEREFORE, the Administrator requests that this matter be assigned to a panel of the Hearing Board, that a hearing be held, and that the panel make findings of fact, conclusions of fact and law, and a recommendation for such discipline as is warranted.
Gina M. Abbatemarco
Jerome Larkin, Administrator