Two Aspen residents face civil allegations that they created a phony caretaker arrangement to fool a national insurance company out of nearly $700,000.
Transamerica Life Insurance Co. filed a 36-page complaint Nov. 12 against Nikifor Budsey II and Janey Gubow, alleging the two engaged in fraudulent behavior that “shocks the conscience.”
The Cedar Rapids, Iowa-based carrier’s suit accused Budsey of making up a story that he was physically debilitated and relied on Gubow as his constant caregiver. Budsey is alleged to have billed Transamerica hundreds of dollars of day for care he did not receive or need, according suit said.
Budsey declined comment and Gubow could not be reached.
“At this point and time I can’t make any comment,” Budsey said Friday when reached by phone. “They have contacted us.”
Through the lawsuit, Transamerica wants a court to order reimbursement of the $696,936 that Budsey allegedly received under false pretenses. The suit also seeks additional monetary damages due to what it called “egregious” conduct by the defendants.
The filing comes after Transamerica began investigating Budsey and Gubow in early January 2019, later sending investigators to Aspen where they took photos of him in grocery stores and parking lots, where he appeared to be functioning normally and without any physical restraints.
The suit alleged that for seven years, Budsey and Gubow represented to Transamerica representatives that their relationship was strictly caregiver-patient and they were not married; however, the company’s investigation showed “Gubow was never seen providing care of any kind to Budsey on any date of surveillance,” according to allegations in the complaint. Budsey’s policy excluded caretaker work provided by a spouse, the complaint said.
“The surveillance confirmed that Budsey did not receive care and he did not need it,” the suit said. “The surveillance also confirmed that Budsey and Gubow are living together as husband and wife. Upon information and belief, this is because they have been married for all or substantially all of the period of Budsey’s claim for benefits.”
During a January 2019 assessment, Budsey, now 60, had continued to tell Transamerica officials he needed a wheelchair and walker, as well as a urinal/bedpan.
Suspicious about the authenticity of Budsey’s purported situation, Transamerica in early 2019 began looking into his activities, starting with a social media check.
“To Transamerica’s surprise, this check led to Transamerica’s discovery of photographs of Budsey and his daughter hiking together in the wilderness on or about August 20, 2017 — i.e., during a time period when Defendants represented that Budsey was receiving care in the home 24/7, needed a walker and could not so much as set foot outside the home without hands-on assistance from Gubow,” the suit said.
The investigation led Transamerica authorities to discover Budsey’s driving history included drinking-and-driving related charges and a license suspension. That prompted the company to begin surveillance of his behavior in July 2019.
“He was active in the community alone on multiple dates, transferring in and out of a car, driving the car (both by himself and, at other times, chauffeuring Gubow), reaching and bending, shopping for groceries, and lifting heavy objects including a steel bicycle rack, among many other movements and tasks directly analogous to the ADLs Defendants claimed he was unable to perform,” the suit said.
Investigators also snapped a photo of Gubow skiing, which conflicted with a time when she was supposed to have been caretaking Budsey, according to the suit.
There were other incidences in 2020 that led Transamerica to believe Budsey and Gubow were gaming the system.
“Gubow was never seen providing care of any kind to Budsey on any date of surveillance,” the suit said. “The surveillance confirmed that Budsey did not receive care and he did not need it.
Budsey would file reimbursement claims with Transamerica for Gubow’s services, with the insurance company’s understanding that Budsey was paying Gubow for the care she provided them.
“By misrepresenting the amounts Budsey paid Gubow for care, if any, Defendants were able to pocket hundreds of thousands of dollars in benefits they were not lawfully entitled to receive,” the suit said.
Both defendants face claims of fraud, civil theft and civil conspiracy.
Source: Google | Insurance News