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Archive for October, 2010

Healthcare Fraud Roundup

Thursday, October 14th, 2010

What are the fraudsters doing these days? Well, according to reports, NOT getting away with healthcare fraud. The government is in hot pursuit of those that are bilking the system.

Some recent arrests include:

A Michigan podiatrist was accused of filing more than $800,000 in fraudulent claims. The doctor billed insurance providers for surgical procedures performed after falsely diagnosing patients with foot infections.

A New York surgeon was charged with stealing $3.5 million from insurance companies. The Department of Health & Human Services also investigated his billing patterns and found he had allegedly billed for multiple hemorrhoidectomies, office visits and examinations on the same day for the same patient on multiple occasions.

A Chicago-area cardiologist was ordered to pay $20 million and sentenced to 5 years in prison for defrauding both private and public insurers. The whistle blower on the case was another physician who worked in the same office.

Two West Virginia internists were sentenced to one year and one day of prison time after admitting to their involvement in a pill mill scheme. The local pharmacy where the prescriptions were sent by the physicians sold more hydrocodone in 2006 than all but 21 retail pharmacies in the country.

A California pathologist was sentenced to 25 years in prison for prescription fraud. He wrote fraudulent prescriptions for oxycodone in exchange for cash. In some cases the prescriptions were for minors under the age of 21.

In Miami a massage clinic owner was convicted of Medicare fraud. The owner was charged with submitting false claims for physical therapy services that were never given and occupational therapy services that Medicare does not cover.

Healthcare fraud is prevalent, but we’re finding ways to stop the bad guys.

Tips for Protecting Yourself from Healthcare Fraud

Thursday, October 14th, 2010

Rebecca Busch’s healthcare tips were recently featured on EmpowHER a health and wellness site for women.

EmpowHER brings together women of all backgrounds to share their health stories, triumphs and tragedies. For Rebecca’s part, she spoke on what she knows best, healthcare fraud.

Rebecca’s Health Care Tips

1. Counterfeit Drugs
If you take a medication for a chronic condition, save the packaging from the month before and compare the bottle, packaging or the pill itself.
2. Double Billing
Look at your Explanation of Benefits (EOB) after each doctor’s visit. Ask yourself, “Did I actually see that doctor or receive those services?” If the answer is no, call your insurer immediately.
3. Medical Identity Theft
If you don’t monitor your EOBs fraudsters have a better chance of stealing your Medical Identity. This can cause both financial and physical harm – if someone else’s information is included in your medical record you could receive false diagnoses. Take ownership of your healthcare finances and request your medical records and bills once a year.
4. Medication Delivery Errors
Deaths occur each year because patients are given prescriptions at the wrong time, in the wrong dose and of the wrong medications. Make sure you understand your medication regime and that the hospital staff is adhering to it.
5. Phantom Treatments
Some healthcare criminals bill insurance companies for services never received by patients. If you receive a bill that doesn’t make sense, contact the provider or your insurer.
6. Invalid Licenses
Some doctors practice without a valid license. To verify a license, find the Department of Regulation for your state and look up your provider’s name. Here, you can also see if they have ever had a disciplinary action against them.
7. Fake Insurance
Dishonest insurance agents and brokers sell discount cards and insurance cards for fake policies. Any health insurance plans that are priced below industry norms are likely fake. Remember, if it seems too good to be true, it is.
8. Prescription Mix-Ups
Medication errors occur more than you think – a hospital on the East Cost mixed up medication in roughly 1 in 8 prescriptions filled. Take an active role in your care and check your pills to ensure you have been given the drug you were prescribed.
9. Bad & Low Quality Care
Unqualified and untrained surgeons perform surgeries. Doctors use defective medical equipment to perform exams. Check the reputations of your doctors and facilities. Look for complaints lodged against them.