Health-care fraud drains lifeblood from patients, system

Interview with Byron Hollis, Esq., CFE, AFHI, National Anti-Fraud Director of Blue Cross Blue Shield Association


By Dick Carozza

A husband and wife who operated a drug and alcohol treatment program were indicted on 52 counts of health-care fraud. The indictment charges them with taking $1.24 million in funds for services they either didn't provide or services to people who didn't qualify for Medicaid drug and alcohol treatment.

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A large surgery center paid hundreds of dollars to patients who endured largely unnecessary operations and then falsely charged the government. One of the operations involved collapsing the patient's lung to snip a nerve that supposedly would control "sweaty palms."

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An indictment accuses a physician of charging five health-care benefit providers for more expensive procedures than were provided and with improperly dispensing painkillers and anti-depressants.

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Fraudsters, posing as nurses, go door-to-door looking for seniors who need health-care. Instead they collect Medicare and Medicaid numbers and bill the government for services they never provide.

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A jury decided that a doctor's unlawful prescribing of controlled substances resulted in the deaths of five people. He was found guilty of 18 counts of wire fraud, five counts of defrauding health-care benefit programs, and 75 counts of dispensing or distributing controlled substances.

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Health-care fraud affects everyone. Some pay with their lives, others with their jobs, all of us with a smaller paycheck. "Many people believe that health-care fraud is a 'victimless crime' - a crime against big insurance companies who won't miss it," says Byron Hollis, the national anti-fraud director for Blue Cross Blue Shield Association. "But the truth of the matter is that health-care fraud is stealing from your family and your neighbors. When someone commits health-care fraud they are stealing money or services that are then rendered unavailable to someone who may in fact need those services or that coverage," he says.


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