Totally wacky frauds often pop up in health care, and unnecessary surgery at the recently sold Redding Medical Center was the downfall of Tenet. But I can’t remember a case of healthy people voluntarily undergoing surgery for a bribe, as happened in one facility in Southern California. The surgery clinic’s operators were charged today with bilking more than $97m from insurance companies. Apparently over 5,000 people from all over the country were recruited, took the bribes (which were only between $300 and $1,000), had some surgery and then their insurers were billed through a series of shell companies. Apparently the state laws that demand that claims are paid within 45 days meant that many insurers who didn’t have pre-authorization just paid up when they got the bill.
Funnily enough, I had surgery in early April (also in California) and my insurer which also didn’t require pre-authorization, demanded information from me and from several of my providers several times before it would process the claims. After getting the insurer everything it needed, (including a form it told me it needed but had not yet sent me or asked for!) it started processing the claims last week — that’s nearly 120 days later. Given this fraud, perhaps they had a point?
Hatip to California Healthline for this one.