Cover Article

10 popular health care provider fraud schemes

'Do no harm' isn't their motto



Most medical providers are honest and work hard to improve their patients' health. However, a few want to illegally increase the size of their bank accounts. Learn some of the basic health care provider schemes and how to deter them from taking some easy money.

Patients with Alzheimer's disease were sitting unsupervised inside a small room of a medical psychological care facility watching the movie "Forrest Gump" for the umpteenth time. Granted, it's a great movie, but each time the patients sat in front of the tube watching it, the facility submitted insurance claims for providing "group therapy."

I discovered this fraud during my investigation of the facility. It's just one of a long list of crimes committed by a handful of crooked medical providers.

Essentially, fraud in health care is just like in any other industry: Fraudsters with the means and opportunity take full advantage to unjustly profit. Health care crooks inside and outside the industry include patients, payers, employers, vendors and suppliers, and providers, including pharmacists. (Organized crime rings and computer hackers also play roles in committing health care fraud.)

The difference between the health care realm and many other industries is its huge, alluring, easy pile of cash. According to the Centers for Medicare & Medicaid Services (CMS), national health expenditures in the U.S. reached $2.6 trillion in 2010 — 17.9 percent of GDP. The CMS projects U.S. health spending to rise to 7.4 percent in 2014 as a result of the major coverage expansions from the U.S. Affordable Care Act (ACA) — an estimated 22 million people will be insured. Over the period of 2015-2021, health spending is projected to grow at an average rate of 6.2 percent annually.

Over the years, I've found investigating fraud committed by health care providers, facilities and institutions to be extremely fascinating, challenging and rewarding. Most associate those individuals and entities with only doing good and helping others. Although that's true of most health care providers and institutions, others do "go south."

In this article, I describe 10 of the common health provider fraud schemes I've found, and I include some cases I've investigated. This list definitely isn't inclusive, but it will get you started on understanding how providers can be tempted to defraud a lumbering system.

(Also see the ACFE's 2013 Fraud Examiners Manual's section on health care fraud — beginning with 1.1101 — to learn more about these and other types of fraud schemes.)

Ten common health care provider fraud schemes

  1. Billing for services not rendered.
  2. Billing for a non-covered service as a covered service.
  3. Misrepresenting dates of service.
  4. Misrepresenting locations of service.
  5. Misrepresenting provider of service.
  6. Waiving of deductibles and/or co-payments.
  7. Incorrect reporting of diagnoses or procedures (includes unbundling).
  8. Overutilization of services.
  9. Corruption (kickbacks and bribery).
  10. False or unnecessary issuance of prescription drugs.

1. Billing for services not rendered

In almost every health care fraud examination I've conducted, I've found evidence that the medical provider or its facility submitted claim forms to government health care plans and/or insurance companies for services and care — that were never provided — and the corresponding patient files had no supporting documentation. It makes sense that if a fraudster would commit any of the other schemes listed above, which takes a bit of brainpower and effort, they might as well throw in some extra dates and codes on the claim forms to try to make some real easy money.

During the early stages of a health care fraud examination or investigation, I identify the reported dates of service listed on the claim forms and then look for any documentary evidence that the patients were at the facility on those dates.

I first check a patient's medical file. If a staff member had seen the patient, obviously somebody should have written something down — even if it was just documenting the patient's height and/or weight. If I find no documentation, I check the facility's sign-in logs. If there's nothing there, I check the appointment calendars.

Of course, you try to be fair and objective. Our ability to empathize with others (including suspects) helps us treat them fairly and allows us to better understand their situations. So, I realize that records can be misplaced, and, occasionally, somebody might forget to write something down. However, a pattern of billing for services and care with no supporting documentation is unacceptable and unlikely to be coincidental.

Healthcare providers' excuses for missing documentation are sometimes almost humorous. Some providers have blamed non-existing floods, fires and even Y2K (remember the "Year 2000 Problem" or the "Millennium Bug"?) for missing documents. I keep waiting for someone to tell me his dog ate the documentation.

Documents alone don't usually prove intentional wrongdoing. Fraud examiners and investigators also will need to locate witnesses who can — and are willing to — truthfully relate what they know about the fraud. That's when well-planned interviews come into play.

Often interviewing the patients whose names are listed on the questionable claim forms can clear things up. They know whether they visited the doctor or not, and — unless they were unconscious when providers examined them — they'll have a pretty good idea what services they received. However, sometimes patients have foggy memories or medical issues that impair their memories of past visits. And the claims might be several years old. In Medicare investigations, an added dilemma is that the elderly patients sometimes die before they're interviewed or before the cases go to trial.

Most people in the medical field are honest and ethical, so fraud usually will bother their consciences. Sometimes they'll just quit their jobs because they don't want to be part of illegal activities. But for those who remain on the job, they often won't tell what they know until they're confronted. I've found it's usually best to interview employees and former employees of medical facilities at their homes or at least away from the facilities. Make sure you leave your business card with them, even if they don't want to talk (yet).

Billings for services and care not rendered often make for simple cases to present in court because the scheme is so basic that even half-asleep jurors can understand it. Even when I'm putting together a health care fraud case that also includes more complex fraud schemes, if I find evidence of billing for services with no supporting documentation, I often include those first in my summary report.

2. Billing for a non-covered service as a covered service

During one fraud examination I conducted, an allergy doctor was providing a treatment, which was considered experimental and therefore not approved by government health care plans or other insurance companies. With a few strokes of a pen or taps on a keyboard, the allergy doctor submitted claim forms and still got paid for utilizing the experimental treatment. She accomplished this by calling it (and coding it) something else that was covered by insurance plans and policies.

Like most other criminals, this doctor rationalized her wrongful actions. She believed she was providing a useful service to her allergy-suffering patients and that it wasn't her fault the government and insurance companies hadn't yet approved the experimental treatment.

Keep in mind that most patients are only concerned with two things: getting healthy (or finding relief from their suffering) and how much they personally have to pay out of their own pockets for medical services. Because the insurance companies are footing the bills (or most of them), patients usually have no qualms as long as they are regaining their health.

In the allergy clinic case, the doctor only gave a few patients the experimental treatment; most received approved care. But I noticed something unusual when I reviewed the patients' files: The insurance claim forms showed that many patients were treated at the allergy clinic four or five days per week (Monday through Friday). I remember thinking, "I wouldn't come here that often even if they were giving away free lunches." However, when I interviewed some of the allergy doctor's patients at their homes, they told me they only received injections twice a week. Obviously, my case was getting stronger.

3. Misrepresenting dates of service

Providers might make more money by reporting they visited with or and treated the same patient on two separate days rather than one day. Each "office visit" is usually considered a separate billable service. Often the services the fraudsters list on claim forms are actually provided, but the dates are false because it's more profitable for the providers.

So check to assure that the patients' medical file documentation matches the dates of service listed on the claim forms.

Focus on the "date of service" not the date the claim form was signed or submitted because those dates may be several days after the service was provided.

4. Misrepresenting locations of service

Let's get back to that allergy clinic. When I interviewed patients at their homes, many who previously told me they only received injections twice a week, also told me they only went to the allergy clinic once a month. The patients said that the allergy clinic workers would hand each of them a bunch of syringes filled with antigens and tell them to inject themselves in their homes!

Because I'm a bit shy of needles, and the thought of injecting myself makes me cringe, I wondered if insurance companies would knowingly approve self-injections away from the allergy clinic. A specialist from one of the insurance companies told me that it (and most other companies) didn't accept self-injection as a reimbursable expense. The specialist said medical providers should monitor patients for several minutes after injections to ensure the patients don't have adverse reactions.

I examined the claim forms and found that the allergy doctor had reported that the injections were given at the allergy clinic. I started to wonder if the allergy clinic was doing anything legally. I confronted the allergy doctor with the evidence, and she claimed she didn't know this type of billing was improper.

I asked how she determined the day of the week the patients injected themselves when preparing the claim forms, and the doctor said that she just guessed. I thought it was more than a coincidence that she always "guessed" the injections were given Monday through Friday (when the allergy clinic was open for business) and not Saturday, Sunday or holidays (when the allergy clinic was closed). I think she knew that billing for Sunday injections would have raised red flags at the insurance companies.

In other cases, I investigated physicians who had billed for services provided in their offices that were located in the U.S. while the physicians were actually on overseas vacations. These were closer to "no supporting documentation" fraud, but because the physicians didn't take their patients with them on their trips, those claims were really far off!

5. Misrepresenting provider of service

It's a scary thought that somebody might impersonate a physician and bill for treatment, but it does happen. I've conducted numerous investigations in which medical doctors signed insurance claim forms showing that they had provided all the care but in reality, lesser-educated mental health professionals actually conducted the therapy.

In these cases, the affected insurance companies would still have paid for the care provided by the lesser-educated therapists (as long as they were licensed), but they would have paid less. For example, I learned that licensed clinical social workers are often reimbursed less than physicians.

In another investigation, I discovered that a psychological care facility even hired people to be therapists who had never been trained to provide those services. One of those unlicensed providers told me he was hired solely because he was a friend of the owner.

The facility also had hired a part-time doctor to come in the office two days a week to review treatment files and sign claim forms. During an interview, I asked the doctor why he had signed the claim forms when he didn't personally provide the treatment. The doctor was almost defiant when he said he was permitted to do so because he was the supervising physician. I next asked him if he knew that some of the therapists weren't licensed to provide therapy. The doctor shook his head and asked me, "Well then, why the heck are they working here!?" The doctor said he assumed the owner checked the therapists' credentials before hiring them. He also said he didn't realize that the insurance companies paid more just because a physician signed the claim forms.

The doctor also admitted that he normally wasn't on the premises when the lesser-educated "therapists" provided the care, but he rationalized signing the claim forms because he reviewed the patient files before signing. The doctor sadly looked at me and said, "I guess I'm the goat." I replied, "Not if you testify."

I looked forward to interviewing the owner; however, he didn't offer any valid excuses for his crimes. He did say he didn't think he should go to jail because he was extremely overweight.

6. Waiving of deductibles and/or co-payments

Obviously, patients seldom complain when their out-of pocket expenses are low or non-existent.

Most government health care plans and insurance companies don't allow medical providers or facilities to waive patients' deductibles or co-payments. The rationale may be that if patients have to pay something to see doctors, they'll only seek care if they really need it. Perhaps it's also a way to offset some of the expenses. Regardless, some providers do waive patients' deductibles or co-payments and then submit other false claims to insurance companies to make up the dollar difference. Truly unscrupulous providers also will add a bunch of other false services to the claim forms to increase their illegal gains knowing that the patients are unlikely to complain because their co-payments and deductibles were waived.

When I've interviewed providers who waive co-payments and/or deductibles, they often rationalize their false claims submissions by saying that they don't make any extra profit by doing this; they're just helping out their patients who can't afford to pay their medical bills. However, the insurance companies (and/or government programs) often end up paying expenses they shouldn't have to pay, which results in higher premiums for all policyholders or lost tax dollars.

Fraud examiners, investigators, auditors, compliance personnel and analysts should note that medical facilities' financial records should show payments — or the lack thereof — of co-payments and/or deductibles. Patients might also have copies of receipts issued from medical facilities or perhaps even cancelled checks or credit card receipts showing what they paid.

So keep in mind that it may also prove beneficial to interview patients plus current and former medical facility employees. It's been my experience that it's usually tactically smarter to try to interview former employees before interviewing current employees. Former employees don't have the fear of losing their jobs (livelihood) for telling the truth and are less likely to tell their former employers about the interviews. Keep in mind that a company's counsel might say that you can't legally approach and question those current or former employees.

7. Incorrect reporting of diagnoses or procedures

This provider scheme is similar to one often used in the auto repair industry. As you probably know, it costs more to get a car tuned-up then it does to change the air filter. But if an auto-repair business charges you for a tune-up but only changed the air filter, it's making money illegally. Listing an incorrect diagnosis or procedure is essentially the same thing.

Unscrupulous providers can bill for extra services if they report false serious diagnoses or procedures performed. For example, if an elderly patient reportedly fell inside a nursing home, a crooked provider could intentionally misdiagnose her with head trauma requiring the (unnecessary) use of a computed tomography (CT) scan and/or blood tests.

The sky's the limit for potential fraudulent provider claims with the elderly in poor health or patients with severe mental handicaps.

Of course, some diagnoses require longer, more expensive hospital stays. I've studied numerous cases in which patients were often admitted for hospitalization, but they mysteriously "got better" as soon as their insurance coverage ran out.

One of the most popular incorrect reporting of procedures is unbundling. In simple terms, unbundling is similar to going to a fast food restaurant and ordering a value meal — a burger, fries and soft drink for $5. However, when you look at your receipt, you find that the restaurant charged you separately for each item so that your total bill was $6.50. Obviously, the business makes more money by unbundling the package deal.

So, simple unbundling occurs when a provider charges a comprehensive code plus more component codes. Here's a theoretical example from the ACFE's 2013 Fraud Examiners Manual. A correctly billed procedure for a hysterectomy would cost $1,300. If a medical provider were to unbundle that procedure, it might charge that $1,300 plus $950 for removal of ovaries and fallopian tubes, $671 for the exploration of the abdomen, $250 for an appendectomy and $550 for "lysis of adhesions" — for a total of $3,721. (See 1.1130 of the 2013 Fraud Examiners Manual.)

8. Overutilization of services

This typically involves billing for services that aren't really necessary — like completing and billing for an unnecessary car tune-up. Unscrupulous providers use this scheme on hypochondriac patients. Tests and exams can go on indefinitely or at least as long as a patient still has coverage or is able to make payments. Alcohol and drug rehabilitation facilities are ripe for overutilization.

According to the U.S. National Survey on Drug Use and Health "in 2011, 21.6 million persons aged 12 or older needed treatment for an illicit drug or alcohol use problem (8.4 percent of persons aged 12 or older). Of these, 2.3 million (0.9 percent of persons aged 12 or older and 10.8 percent of those who needed treatment) received treatment at a specialty facility." Obviously, there's a lot of potential for fraud in this area.

9. Corruption (kickbacks and bribery)

Like all industries, the potential for corruption in the health care industry is great. Providers have been known to unlawfully pay for and/or receive payment for referrals. Obviously, that practice can lend itself to abuse when referrals are made for services that aren't even needed, such as X-rays, MRIs, prescription drugs, etc.

To prove a bribery/kickback scheme, you must establish quid pro quo ("this for that"). Substantiating that the provider paid or received something of value in return for referrals is paramount and not very easy to do. Sometimes the kickbacks or bribes are hidden or disguised in the form of luxury vacations, discounts on facility rentals or hidden gifts as compared to just slipping a check or cash under the table. I investigated one provider who made inflated office rental payments to another physician to disguise his kickbacks for referring patients to him.

10. False or unnecessary issuance of prescription drugs

Prescription drug abuse is sometimes defined as taking prescription medication (prescribed or not) for reasons beyond physicians' intentions. I first became aware of the severity and growth of this problem after reading " Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.," a 214-page 2005 report prepared by the National Center on Addiction and Substance Abuse (CASA) at Columbia University. According to the report, the number of U.S. citizens who abuse controlled prescription drugs nearly doubled from 7.8 million to 15.1 million from 1992 to 2003.

Painkillers are the most commonly abused prescription. These drugs' street value is almost 10 times the legal prescription value. Media around the country often report that thieves have robbed pharmacies at gunpoint to get painkillers. Crime prevention tips often suggest that homeowners should ensure visitors —especially children and teens — don't have unneeded access to the occupants' prescription drugs. The CASA report shows that reported overdoses are increasing.

Some patients "doctor shop" to obtain drug prescriptions — especially painkillers. The doctors usually have no idea that the patients have already visited other physicians to obtain the same or other drugs. Fraudsters can easily recover the cost of the doctors' visits and filling of prescriptions by selling some or all of the drugs on the street. Some patients — and even medical facility employees — have been known to steal prescription paper pads and forge prescriptions and provider signatures. Others make pen-and-ink changes to the quantity and/or authorized refill numbers on the paper prescriptions. (Electronic prescriptions from providers to pharmacists are helping prevent this fraud.)

According to the CASA report, 28.4 percent of surveyed pharmacists reported that they didn't regularly validate the prescribing physicians' DEA numbers (assigned to them by the U.S. Drug Enforcement Administration, which permits them to prescribe drugs) before dispensing controlled drugs, and one in 10 pharmacists rarely or never did.

I conducted an investigation in which a pharmacist stole large quantities of painkillers from his employer's inventory and then electronically submitted false claims to insurance companies using names of other beneficiaries' and their insurance policy numbers, which he obtained from his employer's computer. The pharmacist was smart enough to slip cash co-payments out of his own pocket into the cash register so there wouldn't be a financial shortage for his employer. To further avoid detection, he regularly submitted only a few claims for low quantity under each beneficiary's name. Submitting a claim for 1,000 painkillers under one patient's name in one day would have raised red flags.

The insurance beneficiaries never even knew that the pharmacist had illegally used their names and insurance policies because most didn't receive explanation of benefit forms in the mail from their insurance companies for prescriptions filled under their names. None of the insurance beneficiaries lost any money in the scheme.

When I confronted the pharmacist, he claimed he lifted weights daily and needed the painkillers for his soreness. (I could tell that he hadn't been lifting anything heavier than pill bottles.) If he had ingested all the painkillers he stole he would have been dead from an overdose. The investigation later proved that the pharmacist was selling the painkillers on the street for cash. Some acquaintances of the pharmacist said they paid him for the illegally obtained drugs.

Claims can only be submitted, processed and paid when all of the required protected identifying information (PII) is listed on the claim forms. That PII will include the patient's: name (and beneficiary name if not the same as the patient), date of birth, insurance policy number and possibly Social Security number. PII is the key that opens the safe deposit box. Without it, no claim will be paid.

Don't blindly assume that the "patients" whose names are listed on the claim forms actually received anything. A cautious fraudster may simply include a few low-dollar false billings on several different patient claim forms to stay under the radar: 200 false prescription claims at $50 each often will receive less scrutiny than one false claim for $10,000. So remember, don't dismiss small-dollar claims listed under individual patient names because they could be part of a higher-dollar fraud scheme. The names are still important data that you shouldn't overlook.

A crooked pharmacist could also alter the quantity listed on legitimately received prescriptions for painkillers (or other drugs), manipulate the patients' paperwork and receipts or make co-payments like the above pharmacist and steal the extra drugs for himself. Possible schemes are endless.

Know the schemes

The health care profession is filled with honest, ethical, dedicated and committed individuals. However, like all industries, there are those who betray their colleagues and society.

The scheme descriptions in this article will get you started in learning how to battle this scourge, help victims and reduce soaring health care costs.

Charles Piper, CFE, CRT, is a private investigator, consultant and owner of Charles Piper's Professional Services in West Tennessee. Visit www.piper-pi.com. He can be reached at: pipercfe@cs.com.




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My husband was finally approved for a cancer clinical trial medicine put out by Bristol Myers & Squibb back in 2010. We lived in Tx at the time and the hospital doing this trial for BM&S was MUSC Hospital in Charleston, SC. We sold our home which was 2 yrs old at a big loss so we could get there for his 1st injection of 6….so hopefully after 6 months this medicine which we were told placed 3rd & 4th stage cancer into remission and God willing my husband would be one especially after getting approved 10/2010 and his 1st appointment was 4/4/2011, 6 months later. Long story short, by husband was never given the medicine he was approved for…… I knew right there and then my husband gave up his fight and died one and a half months later. He was brought back to PA where we had lived prior to moving to TX and had a military funeral on Memorial Day weekend 2011 which was also our 28th wedding anniv. I flew back to now was to have been our temp home until my husband’s cancer would have gone into remission, to now, my
 
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I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
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I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
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I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
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I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
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I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
I initially invested a total sum of $95,000 over a period of 18 weeks. My bonus/profit was $170,000, every attempt to make withdrawal failed and I was instructed to make another deposit of $25,000 before I can make withdrawals which I did. Up till now I’m still unable to make withdrawals and all attempt to contact my broker has failed. This is very pathetic and I advise everyone to desist from binary options generally. I did a due diligence test before investing with them but guess what I ended up getting burned. This is to create awareness, not everybody can be as lucky as I was. I’m saying this because I was able to recover my funds through the help of Mr Geroge Robert Thanks to Mr Geroge he’s a private investigator and quickrecoveryagents you can contacts him on email georgerobert0473@gmail.com
 
By Anonymous
Being a MD myself, I recently got scammed by a family medicine doctor at Mercy health. They billed me for something I didn’t ask for. I spent whole day talking to several people and no one would correct the error. If doctors can cheat another doctor, I cannot imagine how they can take advantage of people who have no idea about medicine! No wonder people most people avoid seeing doctors! It is frankly disgusting! This needs to change!
 
By Anonymous
Very good info that covers types of health care fraud. In my case the type isn't covered in your innfo. Maybe you can also add billing for mileage, furnishing no invoices, just a letter of how much is owed and how far you are behind in payment when no bill was ever received. I gave this a 4 rating only because the mileage and ways it can be done isn't covered.
 
By Anonymous
I needed to know this information right now as I am in the middle what I consider complete medical negligence and I need help. I am trying to figure out what to do for my health at this time and just not sure how to proceed. This is a very scary time for me right now. I need answers is urgently as I can play this is an incredible load of information that I am so thankful for. This is a very large Healthcare System in a county in Florida and I have sought some legal advice and I'm waiting on that so just not sure what to do right now. Suggestions would be so helpful at this time if possible. Five star rating if not more
 
By Anonymous
Hello and thank you for giving me insight into fraudulent medical activities. In the past, I have been given a beneficiary form to fill out by a medical facility that named an unknown person as the beneficiary. When I had asked why must I sign the form, it was explained to me, it was to ensure payment of my medical bill if it was not paid by my insurance companies (BlueCross Blue Shield or Medicare). Although, not the very best insurances, nonetheless, one or the other tends to always pay with little and mostly no problem. The most recent doctor I am seeing this morning has requested of me the very same thing. Why is it necessary for me to fill out such a form? Sounds like fraud to me! What is your expert opinion on this matter? Thank you for your time. Marian
 
By Anonymous
Hi, I want to talk about coders who are UPCODING the Diabetics A1c's for profit. It's bad enough to have diabetes but when the coders are WRONG and you pay more money, more meds. and ALL the medical supplies, THAT'S PLAIN WRONG. plus the AMERICAN DIABETES ASSOCIATION uses the same chart that is in the Google. COKER GROUP LLC.........................................THIS COMPANY HAS SCREW MY LIFE .............Almost every three months. 2400 Lakeview Pkwy, Ste, 400 Alpharetta, Georgia 300069
 
By Anonymous
It's too bad that you don't have information about a nurse who takes care of a disabled seven-year-old on Medicaid but yet is not supposed to but babysits hurt nine year old sister while the mother is at work
 
By Anonymous
Beth Israel Hospital satellite Healthcare facilities Mass. My yearly check up i’m having my vitals taken by the nurse, and she handed me a survey attached to a clip board and asked to fill it out, -It’s a suicide questionnaire asking me various questions concerning ones mental health status. 20 Questions: Do you feel like hurting yourself, Are you using Drugs, alcohol, have you Felt depressed at all in the past year,etc,etc..My responses were all No, no, no,no... not much of a decision, I’m a pretty level headed guy that rarely has the blues ever, The survey didn’t apply. So, I got the Bill for my visit 30 days later, and find out I was Charged $56.90 to answer 20 questions on a survey?? What the hell is that about? How does that work? What if you step off the curb and accidentally get hit by a bus after filling it out with all No answers? ... charged $56.90 to fill out a survey.... tell me that’s not a snake oil scam
 
By Anonymous
Yea, I'm in overwhelming agreement with others commenting on this--Fuck this author and fuck health insurance companies. Hopefully some day articles like this might as well be equivalent to Jim Crowe material. Anyone who is a defender of the mafia-like middle men insurance companies couldn't care less about their fellow American citizens.
 
By Anonymous
Yea, I'm in overwhelming agreement with others commenting on this--Fuck this author and fuck health insurance companies. Hopefully some day articles like this might as well be equivalent to Jim Crowe material. Anyone who is a defender of the mafia-like middle men insurance companies couldn't care less about their fellow American citizens.
 
By Anonymous
Dear Charles, We appreciate you and need more in our position. Your information is very helpful and people need to be aware of this and contact their Insurance Companies if they become aware of any of the above. Ive personally witnessed not only Elder Abuse, which is so heart-breaking, devastating and cruel. in addition included fraudulent claims, and down-right dishonestly to family; who cannot see the true condition of the patient. The patient is well going in or transferred from a hospital to a facility. The family is told via phone something far worse of their family member. They put them on drugs that eventually put them in the condition that was initially falsely told to the family. I know this as I knew our loved one far better. And simply made arrangements to have transported home. I called facility and told them the Medical transport will be there at noon to pick up Mr. Jones. When he arrived home the transporting gentlemen padded me on the arm and said good job. and Mr. Jones got cup out of
 
By Anonymous
 
By Anonymous
Hi, I discovered a urologist of Scarborough Hospital made a number of claims from my Personal Claim History back in 2015 with a referral from my former urologist after my surgery in a research after I found the surgery had been a fraud from document given by HPARB, Ontario. The total false claims amounts to $694 including an $80 consultation which did not exist. My former urologist has also made "Day of Discharge-Best Phys" claim on my day of discharge when he didn't show up. Do I have a right to claim a violation of privacy act on his sharing of my health information with the guy I have never visited? My email: Medimalpracticetrt@gmail.com. Your replay will be highly appreciated! SF
 
By Anonymous
These people took away all my money. It was a painful experience with all this so called scammers . But I just got back my refund with the help of Mr john smith Feel free to contact him through his telegram ID @jonhsmith3371 / his private email jonhsmith3371@gmail.com make sure you always seek my advice as you will be working with him he can also guide you on how to trade crypto currencies
 
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Can a insurance company wait years to inform you of a huge copays amount accumulated over 4 years and expect payment ?
 
By Anonymous
Went to my Dr for regular check up and to have him sign my paperwork to get my handicapped placards renewed. He said I would have to make another appointment and pay another co pay for him to sign my paperwork.is this against the law?
 
By Anonymous
Can someone investigate a hospital for fraudulent drug screening?
 
By Anonymous
Screw the insurance companies. I enjoy reading stories about them getting ripped off. What goes around comes around. The author of this article is a piece of shit for helping them. Busting a provider for not charging a patient the co-pay they can't afford. Go fuck yourself...
 
By Anonymous
 
By Anonymous
Question : My son was aged off ins at 26 by ins co, but still are taking out money for ins for him to be on it. when they are so quick to take him off. Am I entitled to a refund of 1 yr of payments to ins co that was payed out ? I didn't notice in pay that it was still being taken out and its very upsetting that they are so quick to kick him off policy but yet to still take my money. Can anyone answer this question ? k
 
By Anonymous
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By Anonymous
This happened to me. I had a mental health caseworker that only saw me once a month. I say "only" because it wasn't really enough to do anything and by the time she saw me again, she forgot what we were supposed to be working on. I figured maybe she had other clients that had more urgent matters. Eventually, I asked though why we only met once a month but she said she had in her planner we were meeting 3-4 times a month. I figure that's also what was going to the insurance company. Since I'm the one with the mental illness and there's no proof or witnesses it's a lost battle and a waste of my time. Trust me though, I was depending on these services so I would definitely know if I was receiving them or not.
 
By Anonymous
So, how doe shtis article help anyone? I see NO RESOLUTIONS here!
 
By Anonymous
so here's a quick question: Is it illegal if the hospital you went to billed your parent's insurance, even though you went and were treated as an uninsured patient? Also, you never gave the hospital your parents info, not even their names, so you have clue how they obtained it? (My parents live in a different state and this is exactly what is happening to me and we don't know what to do.) This is also after I paid the fees and now they are billing the insurance $500.
 
By Anonymous
EXCELLENT. This is one of the best articles I have read in hours of reading. I do lots of internet research for my job as a court transcriber for 15 years and this article has been a ray of light in tonight's search for justice. WOW.
 
By Anonymous
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By Anonymous
boo hoo..poor insurance companies. Who would ever want them to get the fucking they deserve. Insurance companies are the real fraudulent fuckers here
 
By Anonymous
Help us stop the violation of citizens' rights. https://youtu.be/FFW3actIQX0 SEE🕵🏻‍♀️ http://hospitalinspections.org/report/18812 https://change.org/p/governor-bobby-jindal-louisiana-secretary-kathleen-sebelius-hhs-stop-patient-abuse-and-cover-up-at-lsu-health-sciences-center-shreveport-12bbe945-b759-4e98-950a-bfc0d6689619 📸 https://youtu.be/oJ8mn-Xt-tc Shreveport La Mayor/Sheriff/Police/Hospital/Media allow: Hospital torture, cruelty jails, unfair court, kid export, false arrests, police brutality. Please tell law enforcement that isn't corrupt this: Did you know: Ochsner blocks victims with grievances. LSU hospital torture in Shreveport is ignored completely. Victims of U.P.D. abuse &/or torture (Gabe tortures elderly women) will testify, polygraph if needed to have the U.P.D. officers removed & charged for torturing citizens. Ochsner actively suppress outcry to prevent legal recourse. There has never been response to hospital victims. Site shreveport.gov has 80-90% falsified contact info to reduce lia
 
By Anonymous
Help us stop the violation of citizens' rights. https://youtu.be/FFW3actIQX0 SEE🕵🏻‍♀️ http://hospitalinspections.org/report/18812 https://change.org/p/governor-bobby-jindal-louisiana-secretary-kathleen-sebelius-hhs-stop-patient-abuse-and-cover-up-at-lsu-health-sciences-center-shreveport-12bbe945-b759-4e98-950a-bfc0d6689619 📸 https://youtu.be/oJ8mn-Xt-tc Shreveport La Mayor/Sheriff/Police/Hospital/Media allow: Hospital torture, cruelty jails, unfair court, kid export, false arrests, police brutality. Please tell law enforcement that isn't corrupt this: Did you know: Ochsner blocks victims with grievances. LSU hospital torture in Shreveport is ignored completely. Victims of U.P.D. abuse &/or torture (Gabe tortures elderly women) will testify, polygraph if needed to have the U.P.D. officers removed & charged for torturing citizens. Ochsner actively suppress outcry to prevent legal recourse. There has never been response to hospital victims. Site shreveport.gov has 80-90% falsified contact info to reduce lia
 
By Anonymous
Your review of health care fraud types is extremely valuable. But I question your assumption that most doctors are honest. And I would say--given the extent to which their charges are deliberately arcane--nearly hospitals all are crooked. And most reportage of doctor-hospital fraud involves fraud of the federal government programs. The private sector gets little attention. And almost nothing is exposed about the number of treatments that lack much if any scientific validation. My own special peeve are urologists. Their cash cow is operations for enlarged prostrates. Mine a few years back cost $17.000, But I have been able to find no empirically validated basis for determining when needed except total blockage of urination nor any statisticabout post-operative patient satisfaction
 
By Anonymous
The US health system is flawed. As a man from Florida, Health is one of Florida’s biggest challenges Coverage https://truecoverage.com/shop-affordable-florida-health-insurance. and there are some critical issues that need to be addressed such as the high numbers of residents without Health Insurance. The government must take steps to neutralize this situation in USA.
 
By Anonymous
Now the FOREIGN questionable anything ..trained, to legal in USA to actually licensed: just kill patients very slowly for continued DEATH4$$$$... to Spain, Canada will euthanize dementia patients without permission. Also see Australians posting here(and I know them personally) GOT NEWS for ya l out of 3 in USAs HOSPITALs enter and DIE very slow deaths...due to foreigners...and corporations along with insurance companies inflating the costs...so the longer it takes to MURDER KILL your loved one the more pay they get usual $1 MILLION to $2M per month on each TORTURED INNOCENT HELPED AMERICAN.,.. FACT... intention...Drs enter on same foot run out room to room floor to floor... then hospital to hospital then clinic to clinic...then LEAVE THEIR DISEASES with each starve them and feed them IV TOXIC WASTE causing disease organ failure inability to speak for themselves let alone move form the filthy blood beds the lazy staff ignore on purpose... EVIL is here...embedded. A foreigner M' built a $240M paid in full in
 
By Anonymous
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By Anonymous
I was talking to my friend after a medical appointment. We both read and write English. We were born here in the U.S.A. and are both highly educated and intelligent - - as opposed to most people in this town. My friend went to the doctor to discuss two issues, one of which was a notification of a billing for services and visit that never happened. I want to report the doctor who is a foreigner and whom I suspect is not only a Democrat who believes she is "entitled," but is in the practice of committing fraud; i.e., stealing all our Tax Dollars via Fraud. I told my friend that he/she isn't "so lucky" to be the only patient this foreign Liberal, entitled doctor, has been "double billing." Is there a telephone number we can use to directly report these criminal, foreign, Liberal, Democrat, so-called doctors?
 
By Anonymous
I was talking to my friend after a medical appointment. We both read and write English. We were born here in the U.S.A. and are both highly educated and intelligent - - as opposed to most people in this town. My friend went to the doctor to discuss two issues, one of which was a notification of a billing for services and visit that never happened. I want to report the doctor who is a foreigner and whom I suspect is not only a Democrat who believes she is "entitled," but is in the practice of committing fraud; i.e., stealing all our Tax Dollars via Fraud. I told my friend that he/she isn't "so lucky" to be the only patient this foreign Liberal, entitled doctor, has been "double billing." Is there a telephone number we can use to directly report these criminal, foreign, Liberal, Democrat, so-called doctors?
 
By Anonymous
I was talking to my friend after a medical appointment. We both read and write English. We were born here in the U.S.A. and are both highly educated and intelligent - - as opposed to most people in this town. My friend went to the doctor to discuss two issues, one of which was a notification of a billing for services and visit that never happened. I want to report the doctor who is a foreigner and whom I suspect is not only a Democrat who believes she is "entitled," but is in the practice of committing fraud; i.e., stealing all our Tax Dollars via Fraud. I told my friend that he/she isn't "so lucky" to be the only patient this foreign Liberal, entitled doctor, has been "double billing." Is there a telephone number we can use to directly report these criminal, foreign, Liberal, Democrat, so-called doctors?
 
By Anonymous
his list is not accurate it completely omits the primary indicator of health Care fraud which is repeated billing for services that have already been paid for anybody that doesn't have health care and has received it and paid for in advance can tell you that it is common to receive multiple bills for the same thing over and over again and nobody does anything for it nobody is ever charged for this criminal act that is responsible for all the increases in health care expenses in the USA
 
By Anonymous
So how do I stop the bad doctors who are willing to cut on people with no longer reason?
 
By Anonymous
 
By Anonymous
To whom it may concern : while visiting my Dr.( A few yrs ago) I was trying to decipher my" file that was left on the back of the exam room door. An assistant walked in, started telling at me to " GIVE ME THAT FILE!!" I hesitated as I was surprised at her reaction to a patient reading his own file" She yelled even louder Mr. Jones!! Give me that file!!!!! I handed it over, & stated I find her reaction to reading my own file, suspect. She returned 5 minutes later, & said go ahead & READ IT! & put a file on the door. She left & I did. The file was completely empty of ALL information, except for my name. I wasn't really surprised. I am here, because I was looking for laws or rules?"" That allow me to see what the Drs charge for a particular visit, & what they charged the ins co for. Nada...If insurance companies, called their insured, after a visit, & gave a small interview, I'm sure they would find FRAUD abundant. For an issue I have now....I believe I'm at 5-6,Dr visits & frankly nothing, ABSOLUTELY
 
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**** I like this article but the pharmacies don't all use the NDPD. National prescription database should be mandatory in all 50 states.
 
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By Elle
Good overview of the various different types of healthcare fraud.
 
By Anoop_Kumar
 
By John_4
Charles, I have been around the health care fraud problem from a risk management and fraud controls perspective for 12 years. Your article is far and away the best in identifying some of the problems through story telling. People learn a lot from story telling and you master it. Kudos to you. I devote time to learning more about how environment shapes human behavior and how people affect judgments and make decisions. I think your bang on in explaining how your persons' of interest rationalize doing wrong. New science tells us people dont' make rational choices as once thought. People are predictably irrational (Ref: Dan Ariely 'et al'). People rationalize making bad choices when tempted between what they know is right and doing wrong.
 
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