Phone scams, email and snail mail scams, and even door-to-door scams, they’re everywhere these days, people trying to make a quick buck, that is. And it costs taxpayers, insurance companies, the government. It takes a toll on consumers’ trust and confidence, too.
Health insurance, Medicare and Medicaid fraud cases have been in the news for decades. And while it’s nothing new, the amount of the money paid in phony medical insurance fraud has been increasing consistently.
Take a look at some of the costliest, creepiest and even dangerous-to-the-public-health insurance fraudcases.
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15) A small role could have a big price, but Hollywood won’t come calling: $20
What would you do for $20? A young lady decided that she could be the driver to pick up prescription drugs at a pharmacy, after her two co-conspirators had placed the order using phony prescriptions.
The local authorities working this case were able to catch the woman red-handed as she left the pharmacy. She was charged in December 2006, pleaded guilty in May 2007 and then failed to appear for sentencing that same month. She remained a fugitive until May 2010. The judge in this matter sentenced her to serve 68 days in jail. Sadly, Hollywood execs thought this script was too “bland” for a movie deal.
Source: Blue Cross Blue Shield of Michigan
14) ‘Til fake marriage do us part: $169,000
Some people like to throw big weddings and post pictures of the great day everywhere. Others prefer to run away and get hitched. That’s exactly what an attorney in Michigan said he did; he added his then girlfriend as his “wife” to his health insurance list of dependents back in 2001. But it wasn’t until eight years later, when his senior partner decided to change health insurance companies, the truth was revealed: they were not married. The scam caused a loss of more than $169,000 to Blue Cross Blue Shield of Michigan. The attorney was charged with a felony of larceny by false pretenses, which carries a penalty of 15 years in prison. We’re not sure how his “wife” took the news.
Source: Blue Cross Blue Shield of Michigan
13) The “ghost” doctor: $900,000
From 2004 to 2008, a doctor decided that his untrained office staff would treat patients. He was able to receive $900,000 in fraudulent reimbursements for the services performed by unqualified, unaccredited office staff.
The Centers for Medicare and Medicaid Services audited a random sample of the bills the doctor submitted to insurance companies; 90 percent of those bills should have been denied payment because they were not performed by the doctor.
The doctor pleaded guilty to health care fraud and could serve up to 10 years in prison and pay a $250,000 fine.
Source: Blue Cross Blue Shield of Michigan
12) Two states, $2 million at stake
Both Michigan and Texas arrested six people who defrauded health insurers of $2.1 million in 2010. The scam consisted of billing workers for services that were never rendered at a Texas manufacturing facility. The services were being billed by a chiropractor and occupational therapist offices.
In the end, the owner of the physical therapy clinic, two employees, the chiropractor and the occupational therapist had submitted claims for more than $4 million to health insurance companies. All of the fraudsters and the liaison at the manufacturing facility who “recruited” workers to bill the untendered services face up to 10 years in prison, after being convicted on all counts.
Source: Blue Cross Blue Shield of Michigan
11) This one actually made it to CNBC’s “American Greed” TV show: $2 million
In 2010, an episode of “American Greed” on CNBC profiled Dr. Robert Stokes, a former East Grand Rapids, Mich. dermatologist, who is now serving 10.5 years in a federal prison. He was convicted of health care fraud in 2007 after bilking insurers of nearly $2 million.
Prosecutors and witnesses say Stokes also performed unnecessary and disfiguring procedures on patients and reused surgical equipment in violation of medical rules. Here’s a trailer from the show.
10) Even the nation’s capital is not safe from fraudsters: $75 million
Back in February 2014, 25 people were charged by Federal authorities in Washington D.C. for a large scheme to obtain millions of dollars in fraudulent Medicaid payments. The scheme involved phony claims for home care services. Authorities said that fraudsters were paying kickbacks to beneficiaries to manufacture false claims for nonexistent services, according to a report on CBS news.
One of the people charged was the owner of a home care agency in Maryland who had lost her nursing license and was ineligible to receive Medicaid payments. The report says that Florence Bikundi, the owner of the fraudulent agency, was able to bill the city for $75 million in Medicaid payments.
“Among the property seized from her were millions of dollars from 46 bank accounts, a 7,300-square-foot home valued at $927,000 and five luxury vehicles,” the report said.
Source: CBS
9) Prescription drug cartel in a church
An abnormally high number of accidental deaths from the misuse of prescription drugs in Michigan compelled authorities to conduct an investigation. They found that five doctors were illegally prescribing and distributing prescription drugs. One of the doctors was giving drugs to individuals who agreed to join the church that sponsored his free clinic, and asked church members to bring him their leftover drugs for redistribution.
The investigation also revealed that they were billing the health insurance company for the office visits used to illegally prescribe the drugs, and that patient records were falsified to justify the prescriptions.
All five physicians were charged with varying counts of distribution of controlled substances, health care fraud and the entry of false information into a medical record by a health care provider. Convictions were obtained as a result of plea bargains from all five physicians.
Source: Blue Cross Blue Shield of Michigan
8) Chiropractor conman takes advantage of senior citizens by selling them his self-designed back braces: $1.6 million