Medical insurance fraud: Health clinic sued by BCBS

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PostPosted: Sat Feb 16, 2008 11:45 am   Post subject: Medical insurance fraud: Health clinic sued by BCBS  

Quote:
LOS ANGELES - Twelve state Blue Cross and Blue Shield health insurance plans have sued a group of Southern California health care clinics, physicians and others they say are involved in an elaborate scheme to perform unnecessary surgeries and bilk insurers out of millions of dollars.



The suit was filed in cooperation with state and federal authorities, including the FBI, which had previously filed criminal charges against some of the defendants.



The scope of the alleged fraud is vast. The insurers claim the clinics paid recruiters to enlist patients in 47 states, then transported the people to California where they underwent unneeded and sometimes dangerous outpatient procedures.



In some cases, the "patients" stayed several days and had several different procedures, for which they were paid from $200 to $3,000.



The lawsuit claims the clinics then billed a number of individual health plans for the procedures, which netted more than $30 million.



The investigators said that from August 2002 to April 2003, the defendants recruited more than 5,000 patients nationwide to undergo unnecessary procedures at one clinic and billed almost $97 million to insurers.



Three operators of that clinic, the Unity Outpatient Surgery Center in Buena Park, about 20 miles southeast of Los Angeles, were arrested in July by the Orange County district attorney's office.



Roy Dickson, an attorney who has represented the clinic in the past, said Friday he has not seen the latest lawsuit and could not comment on the charges.



The clinics also coached the patients how to lie to investigators if they were questioned, the suit claims. Patients were offered credits toward future cosmetic surgery procedures in lieu of cash, the lawsuit alleges.



The Blue Cross systems involved are in Alabama; Massachusetts; Michigan; Nebraska; North Carolina; Tennessee; as well as parts of Maryland; Virginia; and the District of Columbia; upstate New York; New York City; Pennsylvania; Washington and Alaska; Oregon; and Utah.



A number of states and the U.S. Department of Justice had previously indicted some of the defendants involved in the alleged scheme. Those charges are still pending.



But the latest lawsuit, filed Thursday in federal court in Los Angeles, is the first time individual doctors are named.



The defendants include nine surgery clinics, seven medical management companies and 34 individuals.



Officials said the scope of the scheme is even larger than alleged in the lawsuit.



The FBI has determined that $1.3 billion was billed as a result of the alleged fraud for a loss of $345 million. The FBI has 21 field offices investigating the case and has already disrupted six operations and indicted three people and one corporation, according to FBI Agent Dan Martino.



Investigators and officials, speaking at a press conference in Washington, D.C., said they were puzzled that the clinics charged in the scheme actually performed medical procedures, including colonoscopies, endoscopies and a procedure to cure sweaty palms that involved collapsing a patient's lung to access the nerves that control perspiration.



"One wonders why they actually had to perform procedures that exposed people to real-world medical risk," said Paul Brown, vice president and deputy counsel of the Blue Cross Blue Shield Association. "The allegations made in this case reveal an incredibly complex and sophisticated way of perpetrating this fraud."





Another reason health insurance is unaffordable, I think this one is terrible considering there are so many with out it today.
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PostPosted: Mon Feb 18, 2008 7:12 am   Post subject: How to fight against medical insurance fraud?  

Scams, scams, scams ......Evil or Very Mad I at times wonder, is there at all a right way to fight against these unlawful activities!!


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PostPosted: Mon Feb 18, 2008 9:06 am   Post subject: Awareness needed to fight against medical insurance fraud  

Hi Lady_in_white, you have the right to get annoyed about, but don't forget that we too share the responsibility to fight against these menaces. The responsibility should not fall only to an individual or an agency. An informed citizen should take every initiative to ring the alarm whenever they come to know about such rackets.


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PostPosted: Mon Feb 18, 2008 9:17 am   Post subject: Medical insurance fraud  

Health insurance has always remained a soft target to perform scams. Its very unfortunate that more and more medical establishments along with the medical practitioners are now-a-days getting involved in these fraudulent activities. And whats alarming, that they are also succeeding in convincing the patients to cheat their respective insurers. May be its the right time to consider this issue very seriously.



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PostPosted: Mon Feb 18, 2008 12:52 pm   Post subject: Medical insurance frauds also cost the society more  

good points, and you know that means big costs for the rest of us, you would think that in the medical profession that they are making enough money to sustain themselves, you never hear anyone complaining about money there, and you always see them out recruiting in the healthcare field. No wonder so many are with out, imagine what is out there that don't hit the papers.

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PostPosted: Wed Feb 20, 2008 2:57 am   Post subject:   

It's very sad, and many people cannot afford it at all. I know many self-employed people who cannot afford to purchase health insurance.

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PostPosted: Wed Feb 20, 2008 3:23 am   Post subject: How You can Spot Medical Insurance Fraud  

"How You can Spot Medical Insurance Fraud:



Quote:
Is it possible to keep yourself from becoming a victim of health insurance fraud? Would you even know what to look for? While there probably are as many different fraud scenarios as there are victims, there is one thing that should always throw up a glaring red flag: health insurance coverage that seems too good for a price that seems incredibly low.



Be wary of unsolicited mail that advertises discounted health insurance, especially if you're not familiar with the name of the company making the offer. Before you take any further action, you should do what you can to research the credibility of the company. Health insurance companies are rated at this web site http://www.ambest.com/. You should also check with your State Insurance Commission to see if the company is licensed to do business in your state.



Most importantly, you also need to read the offer in its entirety, especially the fine print. Be very careful of any salesperson that asks you to pay using cash and/or requires you to pay the total amount of your premium in advance.



If you find that you are a victim of health insurance fraud, follow these guidelines immediately:



1. Contact your State Insurance Commissioner. Find out if they have any other complaints about the company from which you purchased your coverage. Also file a health insurance fraud complaint.



2. Contact your bank or credit card company to stop any future automatic payments that may be scheduled.



3. Contact your local law enforcement agency.



Be sure to have all of your cancelled checks or credit card statements and a copy of the health insurance contract that you signed. Also get a copy of your personal credit report from all three major credit reporting agencies as soon as possible. Many times people who perpetrate health insurance fraud also use your personal information to steal your identity and to commit other fraudulent acts.



Be smart and check out the health insurance company before you sign on the dotted line. As a final precaution, call your local hospital or personal physician and ask if they accept the insurance. If not, at least find out if they have ever heard of the insurance. When it comes to protecting yourself from health insurance fraud, an ounce of prevention really is worth a pound of cure."




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PostPosted: Wed Feb 20, 2008 3:25 am   Post subject:   

And by the way...you can check ratings of any insurance company at the A.M. Best site...assuming they allow themselves to be part of the rating process.

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