Thursday, November 29, 2007

Insurers and government fraud-fighters were slow to catch on to this scheme

By Dennis Jay on Wed Nov 28, 2007 at 6:23 PM EST

One of the most notorious medical scams recorded its first significant conviction today in California. Outpatient surgeon William Wilson Hampton, pictured here, was found guilty of one count of health care fraud. Dr. Hampton and two other surgeons from Unity Outpatient Surgery Center in Southern California are accused of masterminding a horrific plan to entice low-income people from around the country to travel to California to have unnecessary — and sometimes very risky — surgeries. All so the three could enrich themselves at the expense of insurance companies and health plans.
And this scheme seemed to work well. They hired runners who recruited “patients” from nearly every state, enticing them with cash and free vacations to California. By one account, the center performed more than 1,000 unnecessary surgeries and is part of a larger scam that has billed insurers for nearly $100 million. The FBI says its the biggest healthcare fraud scam it’s ever encountered. When the case broke in May, county DA Tony Rackauckas lamented:
“It is unfathomable that a doctor would treat patients as if they were bodies on a medical conveyor belt for a quick buck.'’
Insurers and government fraud-fighters were slow to catch on to this scheme. It flourished a long time before it was shut down. Hopefully fraud fighters will use this case to understand how others may be operating and develop red flags to increase detection.
Today’s conviction is far from a complete victory for prosecutors. Hampton was acquitted of one charge and jurors deadlocked on 10 others. Prosecutors say they’ll decide next week whether charges will be re-filed.
But at least the one that struck answers the question of guilt. The big question that remains, though, is why a seemingly intelligent person who has the gift to become a surgeon and a healer — and earn a great living — would jeopardize it all and cut people open for the sake of a few dollars. It’s baffling.

Posted in Medical fraud

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