I recently read an article in the June/July edition of the AARP Magazine on healthcare fraud. The article was titled, “The $80 Million Healthcare Fraud,” and described the criminal activity of a family of chiropractors who operated the Dolson Avenue Medical Clinic in New York. It appears the two brothers, both chiropractors who owned and operated the clinic, had been fraudulently billing private health insurers and Medicare for many years. How? By charging for services never provided….by charging for unnecessary medical procedures…by getting kickbacks from medical device suppliers. Both brothers were convicted in federal court and one still remains in prison. Read the Department of Justice’s press release here.
Why should this be of concern to you? Because their fraud and greed costs you money. How? You don’t think those health insurers just pay those increased (and fraudulent) medical charges out of their profit do you? No. They increase your premiums and take that money out of your pocket. Are you still impacted if your bills are paid by Medicare? You better believe it. The American taxpayer funds Medicare so again, the costs of healthcare fraud is paid for by you.
What can you do? Read your bill and question its accuracy. Read your Explanation of Benefits (EOBs) to see if you were charged for tests and treatments you did not receive. If you see fraudulent bills (especially if your are a Medicare beneficiary), it is doubtful you are the only patient of that doctor, clinic, or hospital who is being used to “rip off” the system. If Medicare is the payor, you may have a False Claims Act claim against the healthcare provider. The False Claims Act (FCA) provides that you may be able to recover damages and penalties against the healthcare provider. The FCA is designed to punish this type of fraud and is set up to encourage patients and others to take action. If you are one of the thousands of health care billing specialists and see this type of fraud, let us hear from you.