Rip-Off Alert: Chicago health care fraud scheme leads to $2.9M in losses

Health care fraud costs American taxpayers more than $80 billion a year, according to a new study. (KSNV)

Health care fraud costs American taxpayers more than $80 billion a year, according to a new study.

In addition to higher premiums and increased out-of-pocket costs, health care fraud could compromise health and safety.

One such example occurred in Chicago, where a facility recruited patients to participate in a false billing scheme.

“Purported patients to sign false paperwork and claim that they were getting medical treatment that they never received,” said U.S. Postal Inspector Erika Hawkins.

The facility charged the insurance carrier for chiropractic service. In reality, patients got massages.

"They would give the patients a kickback for letting them exhaust their deductibles and bill for services that were never rendered," Hawkins said.

An investigation between the insurance company and postal inspectors exposed massive billing discrepancies leading to $2.9 million in losses. Ten patients also willingly took part in the scheme.

“They would give their IDs cards and say, ‘Go ahead; bill as much as you want.’ And they did,” said insurance investigator Gabriel Vela.

The investigation led to the arrests of a doctor, chiropractor and the person responsible for billing.

"In many cases a lot of these doctors, they get a little slap on the wrist and they get a fine and that's primarily it,” Vega said. “I think by giving an imprisonment of 36 months in this case, I think was great because it also lets the other providers out there that, hey, guess what, it's not just a little slap on the wrist anymore. These guys are going to prison."

How can consumers protect themselves?

"Always check their explanation of benefits when they are either mailed to them or if they don't get a copy in the mail,” Hawkins said. “Log in on line just to make sure the doctor is charging for services that were rendered."

If you have reason to believe you've been a victim of health care fraud, call the Nevada Medicaid Fraud Control Unit at (702) 486-3420 or click here.

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