OPERATION
PATIENT PAYOFF
Stranger than Fiction
04/08/04
These
are the facts: "Scam recruiters" across
the country are locating healthy people who have
generous health insurance plans...and talking them
into traveling to California outpatient surgery
clinics to undergo unnecessary and pretty unpleasant
surgeries. Things like colonoscopies, adult circumcisions,
and sweat glad removal.
What's
in it for these "rent-a-patients"? They
get airfare, hotel expenses, a cut of the scam
profits...and sometimes a little cosmetic surgery
thrown in as a bonus.
What's
in it for the recruiters and outpatient surgery
centers? Big money. The clinics bill the
insurance companies for up to ten times the normal
cost of these procedures–then split the handsome
profits among the doctors and recruiters. Insurance
companies estimate they've been hit with over $500
million in claims.
How
does the scam work? Recruiters are targeting
immigrant populations, soliciting prospective patients
through foreign language newspapers, flyers, and
word of mouth. They also target specific companies
that are known to have generous health insurance
plans, looking for likely candidates. And when
they've sealed the deal, they coach their recruits
on what to say and travel with them to the surgery
centers.
Who
blew the whistle? Not surprisingly, insurance
companies themselves. At meetings of the National
Health Care Anti-Fraud Association (NHCAA), dozens
of insurance companies complained about this new
breed of scam, prompting our Criminal Investigative
Division to launch a National Initiative that would
focus closely on it. Using data analysis, our joint
efforts with NHCAA have connected the dots between
the surgery centers and insurance providers–and
shown that the scam is deeply entrenched and operating
nationwide. Our investigation continues and has
intensified in areas throughout the country.
Our
advice to healthy prospective recruits? Just
say no. It's risky; it's unpleasant; and crime
doesn't pay.
Links: Health
Care Fraud | Common
Fraud Scams
