Huge Billing Fraud Is Cited by Health Plans at California Clinics

Huge Billing Fraud Is Cited by Health Plans at California Clinics

News and Commentary | Fraud Cases
Huge Billing Fraud Is Cited by Health Plans at California Clinics - Insurers, working with the F.B.I., said they have broken up an elaborate scam in which doctors filed more than $1 billion of fraudulent insurance claims. [New York Times Healthcare News]

Sound familiar? This problem has been in the news before. It was exposed by ABC Primetime Live in March 2004. Now Blue Cross and Blue Shield plans have filed a civil lawsuit accusing clinics in Southern California of using runners to recruit many employees from a single workplace to received over-priced and unnecessary services in return for cash.

Businesses in 47 states were targeted for this scam, so don’t dismiss this as a California problem. The most common procedures were colonoscopies, endoscopies and surgery for sweaty palms. Obviously any clinic that tries to copy the successes of these California clinics will use different procedures, if they want to be able to get away with their scam longer.

Remember, you should be constantly monitoring your payments for new unusual patterns. Your fraud detection systems should look for surges in billing at many different levels. If a new scam emerges, you want to know immediately.