Nationwide SIU
Contact | Investigative Services Order Form | Sitemap
Contact Us: 800-960-NSIU (6748)

Faking It: How you’re the victim of health insurance fraud

February 5, 2016 by  
Filed under Blog

Faking illness or a medical condition; doctors giving you treatments you don’t need. These are things most of us could never imagine, or even understand.

But unfortunately insurance companies are duped every single day by con artists looking for a fast buck.

It happens everywhere and you could be the next victim. The worst part? Those of us with insurance pay for it through our premiums.

It’s not just your typical fraudster who might be in on the scams, but people you’d never expect. And the cost of ‘faking it’ adds up to a whopping eighty billion dollars (per year).

“If you took those bills and stretched them, they’d go to the moon and back 17 times,” said James Quiggle, Coalition Against Insurance Fraud.

That’s how much money is stolen every year by insurance fraud.

“Our homes are burned our bank accounts are looted, people get surgeries they don’t need, this is a very dangerous crime that we are all victimized by,” said Quiggle.

“Insurance fraud is the second largest white collar crime that there is,” said Calvin Johnson, State Farm Insurance Agent, South Bend.

The most common form?

“Health insurance fraud is the 800-pound gorilla in the insurance fraud scene,” said Quiggle.

Workers compensation is an easy target for people looking to make an extra buck.

“Maybe they had an injury in the softball game on Sunday then come in on Monday and lie to their supervisor that they were injured on the loading dock,” said Quiggle.

All to score insurance compensation benefits they don’t deserve.

“Some of these scammers will limp into the doctor’s office on a walker or crutches and moan and just act in such pain and the moment they leave the office they toss the crutches in the backseat and drive off,” said Quiggle.

In September an NBC station investigated this woman; she’s walking her dog without difficulty.

“She went to the doctor a week prior and said she can’t bend over, she can barely walk. That she sits at home all day and lies in bed,” said Dorian Bond, Bond Investigations, Arizona.

Lucy, we’ll call her, filed an insurance claim saying she was injured in a truck collision.

Bond says an investigation by the National Insurance Crime Bureau revealed new information…this was her ninth accident in just three years.

The investigator says Lucy’s boyfriend was driving the truck, her family towed the vehicle and friends repaired the damages.

“The sad part about that is oftentimes there are attorneys, medical practitioners and others that are working together to create this and they share the profits from the insurance claim,” said Johnson.

It’s a bogus set-up to steal your money.

Crooked individuals aren’t the only ones causing premiums to go up…

“…big serious money is in inflated and falsified claims by crooked doctors and other medical providers,” said Quiggle.

Quiggle also says medical providers have been known to bill for treatments it would be impossible to perform in a day.

In the case of Dr. Aria Sabit, a neurosurgeon in Detroit, he took it a step further.

“Operated on people’s spines even though these people had perfectly healthy spines, he opened them up and then closed them without doing any work, solely because he wanted to bill the insurance companies,” said Quiggle.

Telling them they needed spinal fusion surgery, even botching some of the procedures.

“When you think of a physician doing something to your body, the very person that you really trust that’s going to operate in your best interest, and then on top of that they get paid thousands of dollars for doing surgery, what a horrible way of ripping off someone,” said Johnson.

In this case, thousands turned into $11 million in Medicare for the false claims…straight to Dr. Sabit’s pocket.

After a judge rejected his plea agreement in October 2015, Dr. Sabit will likely stand trial; he’ll remain in a low security prison in Michigan until then.

So how is this affecting you?

“More money is going out, less money is coming in. So you have to keep a large pool of money there to be able to pay for catastrophic situations, so when people are dipping in the pool when they don’t belong, that drives the premiums up,” said Johnson.

“The cost of fraud is passed on to all of us through higher premiums and the insurance companies have to pay higher investigation costs. Our prosecutors have to spend time prosecuting these cases. It is absolutely a crime that affects everyone,” said Dave Rose, Chief Investigator, IDOI Enforcement Division.

And exactly how much more you’re paying for crooks to make a fast buck…may surprise you.

“On average it costs each family $950 a year increase in their insurance because of their insurance fraud. So basically each of us are paying an extra thousand dollars a year in our insurance because of fraud. It drives rates up,” said Johnson.

False healthcare claims aren’t the only common type of insurance fraud.

Have you ever been driving and someone waves you on but you end up in an accident?…It happens.

Staged accident crash rings will hire fake passengers to exaggerate injuries, and they’ll go to crooked doctors who are in on the scams. Again you end up being the one who pays.


Tell us what you're thinking...
and oh, if you want a pic to show with your comment, go get a gravatar!