Prison awaits 2 buddies who switched identities in medical insurance fraud

January 08, 1993|By R. A. Zaldivar | R. A. Zaldivar,Knight-Ridder News Service

WASHINGTON -- Benny Milligan and James McElveen grew up together, played ball and joined the Navy together, and today, they will go to federal prison together -- outlaws in a caper that sprang from the health insurance crisis of the '90s.

Two years ago, McElveen fell 30 feet from a waterfall, breaking his back. He worked for a small business and had no health

insurance, but his friend Milligan did. Seeing his pal bloody and broken, and fearing he would die, Milligan switched identities with the unconscious McElveen in the emergency room.

He got an operation to fuse his back and avert what the doctor warned would otherwise be near-certain paralysis. The bill came to $41,107.45. There was no way that he and Milligan -- a painter and a mechanic -- could pay that. But Milligan's insurance did pay.

While Milligan was agonizing about whether to tell his employer, somebody snitched. Now they're convicted felons. So is Tammie Milligan, Milligan's wife and the mother of their three young daughters. She's doing her time in home confinement for playing along with the scheme.

"I know what I did was wrong," said Benny Milligan, 31. "But I look back on it and I feel that I had to do it at the time. I don't feel like I'm a criminal in the sense of rapers, muggers and murderers."

"All they did was save my life," said McElveen, 32. The government called it mail fraud, wire fraud and conspiracy. A jury agreed. Milligan got nine months and McElveen got seven. Mrs. Milligan, who is about to turn 29, got four months. They must all serve three years' probation and make restitution.

With 37 million Americans uninsured, a Washington-based advocacy group thinks the Health Insurance Three are "heroes," not criminals. Families USA is asking both President Bush and President-elect Bill Clinton to pardon them.

"Their actions, while legally impermissible, were the product of a bloated health system that incomprehensibly withholds care based on the most arbitrary circumstances," Ron Pollack, Families USA director, wrote in a letter to Mr. Clinton.

Mr. Pollack said he had heard of people switching identities to get health coverage before, but this is the only case he knew that had gone so far.

Milligan and McElveen will be doing their time at a minimum-security prison in Carville, La. The three live near New Orleans. The accident took place near Columbia, Tenn., during a vacation. They were tried in Nashville, Tenn.

Because Benny worked for a contractor for the National Aeronautics and Space Administration, the federal government

was paying his health insurance. So it wasn't any old company health plan he messed with; this was a conspiracy to defraud the United States.

Could McElveen have gotten medical care legally?

Mr. Pollack said all hospitals are required by law to treat any patient in danger of dying. But once a patient's condition is stable, most hospitals have no obligation to cure someone who can't pay. However, many hospitals have funds for such JTC contingencies.

Milligan said Tennessee friends told him as they raced to the hospital that health facilities in the area routinely denied care to the uninsured.

McElveen found out about the insurance switch when he regained consciousness days later and people were calling him Benny Milligan. He kept quiet.

Milligan said he wanted to tell his employer, but was afraid of being fired and getting stuck with the bill. As it is, he and his wife both lost their jobs -- and their health insurance.

They think the government is right to demand restitution, but wrong to imprison them.

"We feel that we are being crucified for saving our friend's life," said Tammie Milligan.

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