by Bill Lamb
Medical Fraud is on the Rise
Following an undercover operation by police, three men, including a doctor, were arrested in Miami for illegally billing an insurance company for patients who never were treated.
“This goes on all the time,” the individual working undercover as the patient explained. “To be honest, this type of behavior has reached epidemic proportions. It’s happening all over the country and affecting everybody and everything, including insurance rates.”
While there are many types of insurance fraud—ranging from the above example to staged car accidents—there’s a more subtle type of fraud occuring. Failure to divulge prior injuries and repeated claims for the same injury cost insurance companies millions of dollars every year. It also raises the rates as much as the more blatant cases previously mentioned.
For example, one of the nation’s biggest retailers is sued two to five times a day. That’s right—a day! I’m fairly certain many of those people actually suffered some type of injury. Many, however, are viewing the retailor as an easy mark because of its size.
With the help of positive identifiers, we find all the addresses a claimant has reported. Then we can search area hospitals and MRI facilities. These are the most common places for ER treatment and MRI studies ordered by physicians, including chiropractors.
While we don’t obtain actual privacy-protected medical information, we can determine when and where the subject was treated. Then records can be ordered with a release or subpoena. We also can tie these treatment dates to other accidents we found through Department of Motor Vehicle records and other sources.