Healthcare Fraud Still OUT of Control!

Although I cannot go into detail, I was recently contacted  about a possible insurance fraud investigation.  In the defense arena, this is an area that we are constantly on guard, but it is so difficult to prove fraud when a person claims pain.

 

There are those cases in which a patient is "doctor-shopping" to get pain medication, but "pain management" is now a cottage industry in which  providers and lawyers are finding more and more ways to game the system. It takes a lot of research, time and money to discover fraud. Yet we MUST be diligent.

 

I recently was made aware of major scam in Pennsylvania and reminded by Robert Stickley

to regularly investigate the medical providers to see if there are pending criminal charges against providers. Even though the following is a year old, it occurred in Louisiana:

 

Louisiana Woman Sentenced for Health Care Fraud 

"On September 5, 2013, in Baton Rouge, La., Sonya Lewis Williams was sentenced to 37 months in prison for health care fraud and money laundering. Williams was also ordered to pay $1,223,471 in restitution to the Department of Health and Human Services/Centers for Medicare and Medicaid Services. According to court documents, Williams operated two companies known as Fusion Services, LLC (Fusion) and Grace Social Services, LLC (Grace). Williams established the two companies for the purpose of using unlicensed social workers to visit Medicare beneficiaries in their homes several times a week to perform case management, counseling, and social interaction services. Williams submitted false claims for reimbursement from Medicare indicating that the beneficiaries had received individual, face-to-face psychotherapy from a licensed clinical social worker when no such services had been provided. Medicare paid Fusion and Grace approximately $349,715 as a result of the billings. Much of the profits were transferred from company bank accounts into Williams’ personal accounts."

 

Robert's experience taught him  to perform an internet search of plaintiffs' treating physicians in all trucking cases that contain one or more fraud markers.  There are many resources available for free on the internet, including one from the Feds that can be found here:  http://www.irs.gov/uac/Examples-of-Healthcare-Fraud-Investigations-Fiscal-Year-2013

 

You will sickened and shocked when you go to the number of cases in fiscal years 2012, 2013 and 2014 and see how many billions of dollars are defrauded from the federal government.

 

I hope this helps you as it helped me. If there is anything we can do for you, please don't hesitate to call.

Mark Perkins