Te health insurance dilemma has been cleared up for me.

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PostPosted: Mon May 26, 2014 7:03 am   Post subject: Te health insurance dilemma has been cleared up for me.  

For the past few months, I've been investigating a surgery center whom I have reason to believe is billing large insurance companies in a fraudulent manner.



For the past 5 or 6 months, I've gone through thousands of pages of board of directors and governing committee meeting minutes, financial reports, audits, etc., etc.



So, last Friday, I was on a conference call with the top guy at one of the largest health insurance companies on he planet and two of his directors.



The conversation went something like this: "Mr. Colbert, we really appreciate all you've done and thank you for making this information available to us. We'll use it to conduct our own investigation and hopefully we'll be able to track down the wrong-doers and notify law enforcement and the regulators."



"That's great, Sir," I said. "I'm looking forward to working with you on this and am confident we can get to the bottom of this very quickly. In the meantime, I just have a couple of questions for you, would that be alright?"



"Sure," he said. "As long as I can answer them without violating, you know HIPAA regulations and such."



"That''s fine," I said, "I understand."



I continued, "Tell me a little about your company's system of checks and balances. If I go back a few years and find where the double and triple billing irregularities began, we can reference that to the new Biller and/or Hospital Administrator and hopefully come up with some questions for them.



"Checks and balances?" He asked.



"Yes," I responded, "tell me about your company's checks and balances system."



"We don't really have one," he answered. The system is based, you know, on good faith - an honor system."



Silence.....



"Okay," I said, "let me get this straight - I want to make sure I understand something. If a surgery center sends your company a bill for one million dollars, nobody is responsible for at least giving the bill a second look? You just write the check and stick it in the mail?"



"What if you knew the Biller at this particular surgery center was currently being investigated by the FBI for Medi-cal fraud and is at least partially responsible for the closing of at least four other surgery centers?"



"Mr. Colbert, we are very busy and have neither the time nor manpower to investigate every single claim - even if it is for $1 Million. That's why I'm happy we have people like you out there who'll bring things like this to our attention."



"Thank you," I said. "So I take it your checks and balances system is more reactive than proactive?"



"Exactly," he said.



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Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
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PostPosted: Tue May 27, 2014 8:03 pm   Post subject:   

Add to that the 18-24 months of investigation time the FBI and/or Dept of Insurance will add to the picture, and it's no wonder some of the worst medical insurance fraud ends up being $10--,$15--, $20 million or more. All at consumer expense. Very little of the money stolen is ever recovered in the form of restitution or asset forfeiture.



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CA-licensed Life & Disability Analyst. CA Insurance Lic #0596197. Also investigating insurance company abuses, and providing litigation support/expert witness services. Send me your questions, and I'll send you my answers.
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PostPosted: Wed May 28, 2014 2:44 pm   Post subject:   

For me, recovering the money isn't really the issue. I'll work to see the Billers and CEOs added to the list of the unemployed.



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Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
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PostPosted: Wed May 28, 2014 9:51 pm   Post subject:   

I'd rather see them added to the list of federal incarcerateds.



_________________

CA-licensed Life & Disability Analyst. CA Insurance Lic #0596197. Also investigating insurance company abuses, and providing litigation support/expert witness services. Send me your questions, and I'll send you my answers.
MaxHerr
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MaxHerr
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PostPosted: Thu May 29, 2014 5:00 pm   Post subject:   

I just sent 58 files to the Manager of a Medicaid Special Investigations Unit. I guess we'll wait to see what happens......anxiously.



_________________

Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
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InsInvestigator

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Location: Central California
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