RALEIGH, NC -- A couple ripped off medicare to the tune of millions of dollars, so do why you end up paying the bill?
It is one of the most common types of health care fraud. You get one procedure done, but the doctor, clinic or company bills for a more expensive one. So this is it's driving up the cost of health care and, we're all paying the bill.
"A very complicated, complex procedure is billed to Medicare to generate a higher payment to the provider," explained Michael Carroll, a US Postal Inspector. A growing problem as more and more people live longer and are on Medicare.
And Carroll said that this fraud can effect more people than you might think, "What that ultimately does is it raises medical costs for everyone. In essence, every single person in this country is a victim of this crime." The story begins with Donald and Shirley Blaine, a husband and wife duo who formed a company called Respa-Test.
"They were claiming they were doing these very complicated sleep studies which would require overnight monitoring of oxygen, and heart rates, and things like that by a doctor and a staff," said Carroll.
The investigation showed that the procedures completed in the office were very simple, low cost procedures that might be billed to Medicare for $3 or $5. But postal inspectors say the Blaine's charged Medicare close to $500! Carroll said, "Everyone's premiums, everyone's costs, everyone's insurance costs, medical costs go up as a result of a fraud like this."
Some advice from Postal Inspectors: keep a close eye on your medical and insurance bills.
"If you go to the doctor for a relatively simple procedure and you see something that appears to be much more complicated billed, or your explanation of benefits appears to be much higher price than what you think it should have been billed at, then you need to call the insurance company," explained Carroll.
The Blaine's eventually plead guilty prior to pay $5,000,000 in restitution.