Couple accused of health insurance fraud

An area couple faces felony charges relating to alleged health insurance fraud.

Darrell Hamm, 40, and Holly Hamm, 42, of Fairfield, made 38 payments on policies while allegedly knowing checks would be returned for non-sufficient funds (NSF), while Highmark Insurance Company paid more than $130,000 in claims, according to court documents.

"The Affordable Care Act, would not allow Highmark to immediately cancel health policies, for NSF," but required a 30-day grace period each time, at the end of which the couple would allegedly make another NSF payment "so the cycle would start over," according to a criminal complaint.

The couple allegedly provided misrepresentations "on two separate health insurance policies, during the application and claims process, in an attempt to have medical and prescription expenses covered, in which Highmark was not liable," according to the affidavit of probable cause filed May 2 by Tim Biggins, a special agent in the Pennsylvania Office of the Attorney General.

"As a result, Highmark cancelled both standalone policies in March of 2022," according to the affidavit.

From January 2020 to March 2022, the couple allegedly made $110,052 of invalid payments to the insurance company, according to the affidavit.

Charges against Darrell Hamm and Holly Hamm are identical, according to magisterial affidavits: one felony count each of making a false insurance claim, conspiring to make a false insurance claim, theft by deception, conspiracy to commit theft by deception, bad checks, and insurance fraud.

Unsecured bail of $5,000 was set for each person, according to the dockets.