This issue:

1. Featured Case: eBay Used for Medical Supply Fraud
2. What to do before you contact the prosecution
3. States up in arms over Payment Error Rate Measurement Rule

1. eBay Used for Medical Supply Fraud

In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, and PediaSure, and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.

In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, PediaSure and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.

The investigation reportedly started after Wanda DeGolier bought PediaSure from Hansen on eBay. Ms. DeGolier contacted the medical supply company after she noticed that a label on the box that said the supplies were intended for Hansen’s daughter. Read the Seattle Post-Intelligencer article

I spoke at the ACFE Insurance Fraud Conference in Hartford, CT August 24. You can download my presentation materials, download the article or read the article online.

Some of the other presentations were facinating, especially the presentation Cam Towers Jones did called Prosecuting Multi-Jurisdictional Health Care Fraud Cases. Ms. Jones is the Assistant United States Attorney with the Criminal Division, Western District of Tennessee. Previously, she as the Health Care Fraud Coordinator for the Executive Office for the United States Attorneys, Washington, DC.

Hospitals, Providers Move Toward ‘Paperless’ Age - Wsbtv.com - Wed Aug 4, 01:57 pm GMT [News4Sites Healthcare]

Last weekend, Aron, a professor of medicine showed me the Electronic Medical Records (EMR) system used at his hospital. This is not simply a way to electronically store information that used to only be on paper. It is an incredible step towards better medicine.

His laptop has a touch screen that allows him to quickly check boxes, which is how he enters most of the information during a visit. Aron showed me some hypothetical cases that he created to use in the classroom.

Hospital accused of Medicare fraud (Miami Herald) - Larkin Community Hospital, in South Miami, and many connected with it are alleged to have bilked Medicare of millions of dollars. [Healthcare Fraud News] According to this article, “At one point, the civil suit states state regulators found that half of all care being given in the small South Miami hospital was medically unnecessary.” The article describes two scams. The first scam involves alleged kickback payments to Jack Jacobo Michel, a physician who later bought the hospital. The second scam involves kickbacks to long-term care facilities, some of which were owned by Jack Jacobo Michel, who at that time, also owned the hospital.

Doctor Indicted - A Middle Tennessee doctor has been indicted on healthcare fraud charges. Dr. Young Moon practices in Crossville. [Healthcare Fraud News] This is part of a trend that first gained national attention in 2001, when Robert Courtney, a pharmacist, was indicted for diluting chemotherapy drugs. He pleaded guilty in 2002. Since the effectiveness of chemotherapy varies greatly, patients don’t know for sure whether they are getting full doses.

AG Announces Indictment of Clinical Social Worker for Health Care Fraud - Oregon Attorney General Hardy Myers today announced that Robert F. White, a licensed clinical social worker in Manzanita, was indicted by the Tillamook County Grand Jury. [Healthcare Fraud News] The Attorney General’s Office accused Mr. White of billing for services that were not rendered.

Clinics Find Surgery Scam Pays - Latimes.com - Sun Jun 20, 12:09 pm GMT [News4Sites Healthcare] Outpatient surgery rent-a-patient scams are in the news again is Southern California. These scams often target low-wage employees at companies that offer health insurance. The clinic pays the insured person to let them do unnecessary surgery. They often employ runners to recruit new patients. Bill Mahon of the National Healthcare Anti-Fraud Association says that insurers have learned from this. In the article, Mahon says, “I think at this stage, most of the industry has learned a great deal from the experience. And they’re making changes to try to stop these things at the front door.”

In this month’s issue:

• Make Fraud Control Everyone’s Job
• Wheelchair Fraud Update
• Let’s talk about Data Mining
• Upcoming Events

Large OH Health Plan Adds the Latest Prevention and Detection Technology in Its Battle Against Fraud - For Medical Mutual, This Emphasis on Anti-Fraud Activities is Critically Important Since Healthcare Fraud is Estimated to Cost American Consumers More Than $100 bln Annually BALTIMORE, 6/7/2004 /PRNewswire/ ViPS a provider of business intelligence… [Healthcare Fraud News] According to the press release, Medical Mutual “often recovers $1 million or more per year in improper payments as a result of its vigilance.” This is a tiny fraction (.05%) of Medical Mutual’s annual revenue of $1.9 billion.