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Local nurse arrested for $50,000 insurance fraud scam

DATE:  June 1, 2015
CONTACT PERSON: Emily H. Harris, 610-891-4163

Media, Pa – Today, Delaware County District Attorney Jack Whelan announced a Registered Nurse (RN) employed by a Crozer-Keystone Health System Hospital faces insurance fraud charges for an injury that occurred while on duty. Jamie Scott, 36, 100 block of Athena Lane, in Ridley Township, was arrested at her home last Thursday by Det. Steven Bannar of the District Attorney’s Criminal Investigation Division Insurance Fraud Unit. Scott is facing felony charges for false insurance claim, theft by deception-false impression, and criminal use of communication facility.

Jamie Scott reported the injury on August 24, 2014, claiming she hurt her shoulder while lifting a heavy patient at work at Taylor Hospital. Scott was evaluated at the Centers for Occupational Health in Ridley Park. After the examination Scott was informed that she could return to work on restricted duty.

Over the course of four months, Scott persistently reported pain in her shoulder and neck which prevented her from returning to work. On Dec. 26, 2014, Scott saw a doctor at Premier Orthopedic Associates for a second opinion on her injury. She informed the doctor that the pain in her shoulder was moderate to severe, which she described as aching, burning, sharp and throbbing. Given that Scott’s symptoms had been present for four months, and that she was not responding to physical therapy, the doctor recommended seeking the opinion of a spinal surgeon and pain management. The doctor also suggested that she be placed on light duty at work. On Jan. 30, Scott returned to the doctor and told him her problem was improving and the pain was nearly eliminated as a result of trigger point injections. She requested that she be able to return to full duty at work.

On February 7, Scott reported back to full-duty at work, however, when she helped pull a patient up, she had an immediate recurrence of her shoulder pain and was unable to work the following day. On Feb. 13, Scott returned to the doctor but after an evaluation, he concluded Scott was able to return to a modified work duty with no heavy lifting. She saw the doctor again the following month, and complained of decreased mobility, joint instability and tenderness along with pain that was aggravated by driving a vehicle and lifting. At a follow up appointment on April 13, Scott told the doctor that her injury was still not progressing and still felt sharp pain in her shoulder, but she felt able to perform light duty at work.

As a result of Scott’s reported August 24 injury, she maintained her health benefits, continued to receive wages at a reduced rate, maintained her employment slot, and medical billing covered by Crozer-Keystone Health System, which is responsible for the first $500,000 per patient for worker’s compensation. 

During the month of April, recorded video captured Jamie Scott at the Ridley Township YMCA instructing TRX resistance band training and spinning, an intense cycling class. The video footage showed Scott having a full range of motion of her shoulder and arm. In the video, Scott did not show any discomfort from her injury while instructing students as she performed inverted resistance band pull-ups, squats and elevated wrist band pull-ups. On one occasion, she is seen supporting the back of a male student with her left arm, securing his back as he descended backwards. An examination of Scott’s timecard revealed she instructed 84 times at the YMCA since the date of her injury, and on occasion taught four times in one week and twice in one day.

As a result of her false claims, Crozer-Keystone Health System spent a total of $50,294 on medical and indemnity expenses for Scott, with an additional $12,000 of outstanding expenses.

“Scott worked this illegal scam for nearly a year so she did not have to work, defrauding TriStar Risk Management and her employer, Crozer-Keystone Health System, repeatedly lying in her workers’ compensation case and to her doctors,” said District Attorney Jack Whelan. “Her arrest sends a clear message that those who commit insurance fraud will be identified and held accountable for their actions.”

Scott was arrested on May 28 and arraigned by Magisterial District Judge Phil Turner. Bail was set at $25,000 unsecured. The preliminary hearing is scheduled for June 29.

Since 2000, the Office of the District Attorney has been the recipient of a grant from the Pennsylvania Insurance Fraud Prevention Authority (IFPA). Insurance fraud referrals are received from a number of different sources including insurance carriers, businesses, employees, concerned citizens and local law enforcement agencies. If you suspect someone is committing insurance fraud, please contact the Insurance Fraud Unit at 610-891-4126.