Don't you love it when you go to the doctor for a check-up and your blood work gets the green check, the doctor is happy with your weight and you get money back. WHAT?!?!?
“They would give their IDs and cards and say go ahead, bill as much as you want and they did, “ says Gabriel Vela, an insurance investigator.
And with that, 10 patients of a physical therapy an sports medicine facility took part in a health care fraud scheme. The idea? Bill the patients for medical treatments they didn't receive and when the insurance company would pay the bill, the medical facility would give the patients a kick back for letting them exhaust their deductibles and bill for services that were never rendered.
An investigation between the insurance company and postal inspectors exposed massive billing discrepancies leading to $2.9 million in losses.
The investigation led to the arrests of a doctor, chiropractor and the person responsible for billing.
“In many cases a lot of these doctors, they get a little slap on the wrist and they get a fine and that's primarily it. I think by giving an imprisonment of 36 months in this case. I think was great, because it also lets the other providers out there that hey guess what, it's not just a little slap on the wrist anymore. These guys are going to prison.”
But health care fraud doesn't always involve a willing patient. So how can you protect yourself from a possible scheme?
Always check their explanation of benefits when they are either mailed to them or if they don't get a copy in the mail, log in on line just to make sure the doctor is charging for services that were rendered.
In this case, the insurance companies are the victims but the public is also a victim because if the insurance companies do not recoup their losses, the premiums go up for everybody and everybody suffers from this type of fraud a new study estimates health care fraud costs American taxpayers more than $80 billion dollars a year.
That's you and that's me.
Again, the best protection you have for your own health care is to open up your mail.
Check your explanation of benefits and make sure what's on there is actually yours.