Showing posts with label Medical Claim. Show all posts
Showing posts with label Medical Claim. Show all posts

Medicare fraud investigation yields 73 indictments


In what U.S. government officials are calling the largest Medicare fraud scheme to come to light, 73 people were indicted Wednesday and charged with a variety of healthcare fraud-related crimes that involve more than $163 million in fraudulent billing.

The indictments were unsealed in five judicial districts and include a number of alleged members and associates of an Armenian-American crime syndicate, according to Acting Deputy Attorney General Gary G. Grindler, FBI Assistant Director of the Criminal Investigative Division Kevin Perkins and Health and Human Services Inspector General Daniel R. Levinson.

The indictments allege that the defendants stole the identities of thousands of Medicare beneficiaries and numerous doctors and used the names to establish 118 shadow clinics in 25 states, all created for the sole purpose of submitting phony Medicare claims.

“The emergence of international organized crime in domestic healthcare fraud schemes signals a dangerous expansion that poses a serious threat to consumers as these syndicates are willing to exploit almost any program, business or individual to earn an illegal profit,” said Grinder in announcing the indictments.

At the heart of the indictments, federal officials said, is an organized crime enterprise known as the Mirzoyan-Terdjanian Organization, so named for principal leaders Davit Mirzoyan and Robert Terdjanian.

According to the charges filed in U.S. District Court in the Southern District of New York, the criminal organization had bases of operations in New York and Los Angeles.

A report by the Associated Press noted that Mirzoyan, of Glendale, Calif., and Terdjanian, of Brooklyn, N.Y., were taken into custody on Wednesday. Terdjanian was jailed without bail by a New York judge Wednesday morning. Charges against the ring leaders include racketeering, money laundering, bank fraud and identity theft.

The nature of the case is different than the typical method used to defraud Medicare – in which clinics recruit beneficiaries and bribe them to allow billing Medicare for treatments that are unneeded. According to investigators, this group created phantom clinics and used the stolen doctor and Medicare member identities to bill the agency.

According to the AP report, investigators were alerted by incongruous claims – eye doctors doing bladder tests, ear, nose and throat specialists performing pregnancy ultrasounds, obstetricians testing for skin allergies and dermatologists billing for heart exams.

“The international organized crime enterprise known as the Mirzoyan-Terdjanian fleeced the healthcare system through a wide range of money-making criminal fraud schemes,” said Perkins. “The members and associates located throughout the United States and in Armenia perpetrated a large-scale, nationwide Medicare scam that fraudulently billed Medicare for more than $100 million of unnecessary medical treatments using a series of phantom clinics. We want to restore the confidence in the nation’s healthcare system and assure practitioners we will not stand by and let their identities be used for criminal gain.”

More ways to help manage medical costs

By
updated 1:13 p.m. ET Feb. 10, 2009

Patients have several tools to help manage medical costs. Here are some additional tips recommended by debt reduction experts.

_ Talk to the doctor about whether all the recommended care is necessary.

_ Ask if a procedure can be done on an outpatient basis, to avoid a costly hospital stay.

_ Can you use less-expensive, generic versions of the medicine you need?

_ Avoid using your credit card. If you pay it all off with that, you lose leverage with the hospital and you may have to pay high interest.

_ Remember your manners. Billing office representatives know how the system works and may be helpful if you don't yell at them.

_ Go beyond the billing office. People with higher levels of authority sometimes can approve larger discounts.

_ Talk to the doctor. A physician may show more sympathy than a billing clerk who hears customer complaints every day.

_ Check in-network coverage. Make sure your doctor, the anesthesiologist and everyone else caring for you is in your insurance network.

_ Document everything. Keep a record of phone conversations and all paperwork so you can show what you were told, by whom and when.

Copyright 2009 The Associated Press. All rights reserved.