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Physicians Not Alone In Committing Health Insurance Fraud

For the most part, when people hear “health insurance fraud”, they conjure up images of doctors billing Medicare and Medicaid for medical services that they didn’t perform as described. Of course, the Allegiant Experts Blog has covered many a story about doctors perpetuating such fraud and thankfully, many of those stores detail the prices they pay for it. However, it needs to be highlighted that physicians are not alone in committing health insurance fraud.

As Paul Lucas of Insurance Business magazine reports, health clinic owners are very much part of America’s problem with fraud in the medical world. He writes that Rose’s Houston Healthcare Clinic owner, Rosemary Phelan plead guilty to insurance fraud last month and received seven years deferred adjudication as well as an order to pay $88,000 in restitution, as a result.

Her fraudulent actions were discovered by Texas Mutual Insurance Company when they were contacted by a doctor who stopped working for Phelan in June of 2012. Pharmacy records indicated that claims for prescriptions written in his name were being submitted as late as October of the same year. Following an investigation, it was determined that Phelan was filing fraudulent claims in order to cash in from the insurance company.

Tim Riley is the vice president for special investigations at Texas Mutual Insurance Company. “It’s important for employers and employees to realize the consequences of workers’ compensation fraud as it affects employers and injured workers,” he is quoted as saying, “Fraudulent behavior not only harms the individual company, but also places an unnecessary financial burden on all participants in the workers’ compensation system. If we remain vigilant in identifying this type of crime, we can greatly reduce its effect on the system.”

Pharmacists are also on the list of guilty perpetrators of health insurance fraud. As reported by just last week, Tennessee-based pharmacist, Joseph Collins has been indicted on health care fraud charges of his own. After a five year investigation between May 2008 and May 2013, Collins was found to have submitted several hundred fraudulent claims for prescription medications to both Medicare and TennCare.

The 56 year-old is the former employee of Woody’s Pharmacy. “Rebif, an injectable drug used to treat multiple sclerosis and oxycodone, were among the medications that Collins claimed to have dispensed,” explains Earlier this month, he turned himself in after being charged with TennCare fraud over $60,000, insurance fraud over $60,000 and computer crimes over $60,000. He has since been released on a $25,000 bond.

At Allegiant Experts, we continue to be disappointed by the number of stories about health insurance fraud that comes across our desks. But, sadly, we can’t say that we’re surprised to learn of them. In truth, they are big reasons why our team of clinical experts remains so committed to assisting attorneys with their litigations against those who commit health insurance fraud.

For more information about our experience, expertise and how we may be able help your case, please don’t hesitate to contact us at 407-217-5831.

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