Medical Mutual of Ohio catches $6.2 million in fraudulent claims
Posted by Sarah Jane Tribble/Plain Dealer Reporter January 07, 2009 18:20PM
Categories: Business Impact, Impact, Insurance, Real Time News, Sarah Jane Tribble
Updated at 6:20 p.m.
Medical Mutual of Ohio, the state's largest health insurer, said it caught a record $6.2 million in fraudulent health-care claims last year, up from nearly $5 million the year before.
The company credits its computer software and a diligent investigative unit, which includes ex-police officers, for the increase.
The privately owned Cleveland-based company, which has 2,700 employees and serves about 1.6 million customers, is one of a growing number of insurers fighting fraud in the hopes of controlling health-care costs in a weak economy.
Health-care fraud typically occurs when doctors and other providers inaccurately bill the insurer or write unneeded prescriptions and perform unneeded procedures, said Lou Saccoccio, executive director of the National Health Care Anti-Fraud Association.
"It drives up cost -- absolutely it does," Saccoccio said. "Three to 5 percent of what insurers pay out in health benefits is fraudulent and that's going to be reflected in the premiums."
Medical Mutual's news of recovered dollars comes during a difficult time for health insurers. Two of the nation's largest health insurers plan job cuts in the wake of investment losses and a weak economy in which employers and consumers are reducing health care coverage. Cigna said earlier this week that it would cut 1,100 jobs, or 4 percent of its work force, by mid-2009; Aetna said last month that it would cut 1,000 jobs, or 3 percent of its work force.
Medical Mutual, the oldest health insurer in Ohio and one of Cleveland's largest employers, has no plans for layoffs -- though it is always "cautious on hiring," said Jared Chaney, Medical Mutual's chief communications officer.
Unlike some publicly traded competitors, the company does not answer to Wall Street, Chaney said.
"We don't have the pressure to meet quarterly targets set by analysts and year-over-year growth goals," Chaney said. "We want to turn a small profit because that profit goes into a surplus."
Medical Mutual has an operating surplus of nearly $1 billion, he said.
It's not all about money for John Shoemaker, manager of the 11-person financial investigations unit at Medical Mutual. "Not only do they steal," Shoemaker said. "In a lot of cases the services that they [doctors] render become questionable and I wonder if they're not hurting patients."
Tags: health care fraud, health costs, Medical Mutual of Ohio, National Health Care Anti-Fraud Association
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Thursday, March 5, 2009
Tuesday, March 3, 2009
HEALTHSOUTH....LARGEST in the NATION!!!! OMG!
BIRMINGHAM, Ala., March 2 /PRNewswire-FirstCall/ -- HealthSouth Corporation (NYSE: HLS) today announced it will participate in the Barclays Capital Global Healthcare Conference on March 10-11, 2009, at the Loews Miami Beach Hotel in South Beach, Fla.
HealthSouth President and Chief Executive Officer Jay Grinney and Executive Vice President and Chief Financial Officer John Workman will be speaking on Tuesday, March 10, at 9:30 a.m. EDT. The presentation will be webcast live and will be available at http://investor.healthsouth.com by clicking on an available link.
OMG!! ANOTHER LARGEST in the NATION!!!!
Pay attention AMERICANS!
About HealthSouth
HealthSouth is the nation's largest provider of inpatient rehabilitative healthcare services. Operating in 26 states across the country and in Puerto Rico, HealthSouth serves patients through its network of inpatient rehabilitation hospitals, long-term acute care hospitals, outpatient rehabilitation satellites, and home health agencies. HealthSouth strives to be the nation's preeminent provider of inpatient rehabilitative healthcare services and can be found on the Web at www.healthsouth.com.
Media Contact
Andy Brimmer, 205-410-2777
Investor Relations Contact
Mary Ann Arico, 205-969-6175
maryann.arico@healthsouth.com
HealthSouth President and Chief Executive Officer Jay Grinney and Executive Vice President and Chief Financial Officer John Workman will be speaking on Tuesday, March 10, at 9:30 a.m. EDT. The presentation will be webcast live and will be available at http://investor.healthsouth.com by clicking on an available link.
OMG!! ANOTHER LARGEST in the NATION!!!!
Pay attention AMERICANS!
About HealthSouth
HealthSouth is the nation's largest provider of inpatient rehabilitative healthcare services. Operating in 26 states across the country and in Puerto Rico, HealthSouth serves patients through its network of inpatient rehabilitation hospitals, long-term acute care hospitals, outpatient rehabilitation satellites, and home health agencies. HealthSouth strives to be the nation's preeminent provider of inpatient rehabilitative healthcare services and can be found on the Web at www.healthsouth.com.
Media Contact
Andy Brimmer, 205-410-2777
Investor Relations Contact
Mary Ann Arico, 205-969-6175
maryann.arico@healthsouth.com
Wednesday, February 25, 2009
Health Care Fraud Fugitive Gets 27 Months
Health Care Fraud Fugitive Gets 27 Months
POSTED: 2:56 pm MST February 24, 2009
UPDATED: 3:22 pm MST February 24, 2009
PHOENIX -- A former Phoenix woman was sentenced to 27 months in federal prison Monday, according to the U.S. Attorney’s Office.
Sheri Dawn Blackburn, 46, was also ordered to pay restitution in the amount of $88,441.30.
Blackburn was a fugitive for almost five years and pleaded guilty to one count of theft or embezzlement in connection with a health care benefit program on July 23, 2008, said Sandy Raynor of the District of Arizona Office of the U.S. Attorney.
Blackburn had been indicted in August 2003 on one count of theft in connection with a health care benefit program and one count of false statements relating to health care matters, but never appeared in court and became a fugitive, said Raynor.
The case against Blackburn was based on an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration, said Raynor. It indicated that in 1998 Blackburn was hired by Eldorado Claims Services, a benefit claims processing company, to supervise health care claims processing.
While working here, Blackburn created a fictitious doctor and paid claims to this doctor for services that were never rendered. Blackburn then cashed 14 checks issued to this false identity, totaling $88,441.30, according to the U.S. Attorney’s Office.
After failing to appear in court for her indictment, Blackburn was a fugitive for nearly five years, said Raynor.
In March 2008, the Employee Benefits Security Administration found Blackburn in Iowa and alerted the U.S. Marshals Service, according to the U.S. attorney’s Office.
Blackburn was arrested in Eddyville, Iowa and was extradited to Arizona, where she has remained in federal custody, said Raynor.
Copyright 2009 by KPHO.com
POSTED: 2:56 pm MST February 24, 2009
UPDATED: 3:22 pm MST February 24, 2009
PHOENIX -- A former Phoenix woman was sentenced to 27 months in federal prison Monday, according to the U.S. Attorney’s Office.
Sheri Dawn Blackburn, 46, was also ordered to pay restitution in the amount of $88,441.30.
Blackburn was a fugitive for almost five years and pleaded guilty to one count of theft or embezzlement in connection with a health care benefit program on July 23, 2008, said Sandy Raynor of the District of Arizona Office of the U.S. Attorney.
Blackburn had been indicted in August 2003 on one count of theft in connection with a health care benefit program and one count of false statements relating to health care matters, but never appeared in court and became a fugitive, said Raynor.
The case against Blackburn was based on an investigation by the U.S. Department of Labor’s Employee Benefits Security Administration, said Raynor. It indicated that in 1998 Blackburn was hired by Eldorado Claims Services, a benefit claims processing company, to supervise health care claims processing.
While working here, Blackburn created a fictitious doctor and paid claims to this doctor for services that were never rendered. Blackburn then cashed 14 checks issued to this false identity, totaling $88,441.30, according to the U.S. Attorney’s Office.
After failing to appear in court for her indictment, Blackburn was a fugitive for nearly five years, said Raynor.
In March 2008, the Employee Benefits Security Administration found Blackburn in Iowa and alerted the U.S. Marshals Service, according to the U.S. attorney’s Office.
Blackburn was arrested in Eddyville, Iowa and was extradited to Arizona, where she has remained in federal custody, said Raynor.
Copyright 2009 by KPHO.com
Wednesday, February 11, 2009
University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults r
Thursday, August 21, 2008
Newport Beach doctor surrenders license in fraud case
Dr. Paul Lessler pleaded guilty to Medicare fraud.
BY COURTNEY PERKES
The Orange County Register
Comments | Recommend
A Newport Beach doctor who last year pleaded guilty to committing Medicare fraud surrendered his medical license today, the California Medical Board reported.
Dr. Paul Lessler operated University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults received unnecessary respiratory treatments. In May 2007, he pleaded guilty to three counts of conspiracy and health care fraud charges.
According to medical board documents made public today, Lessler hired recruiters who found patients at board and care facilities in Orange County from 2000 to 2006. Recruiters lured them with soda, candy and doughnuts. The lung treatments were provided without supervision at the boarding facilities. Documents say the medical office billed Medicare for the services, even though those services were not provided in the doctor's office, as required by Medicare.
Lessler, 70, agreed to give up his license and signed an agreement with the medical board to do so in July. Santa Ana attorney Raymond McMahon, who represented him in the proceeding, is on vacation and could not be reached for comment.
Federal records indicate Lessler was to be sentenced last month, but the computer system does not indicate the disposition. Neither his defense attorney nor prosecutors could be reached late today.
Newport Beach doctor surrenders license in fraud case
Dr. Paul Lessler pleaded guilty to Medicare fraud.
BY COURTNEY PERKES
The Orange County Register
Comments | Recommend
A Newport Beach doctor who last year pleaded guilty to committing Medicare fraud surrendered his medical license today, the California Medical Board reported.
Dr. Paul Lessler operated University Pain Specialists, a clinic where prosecutors said he participated in a $12 million Medicare scam in which mentally ill and elderly adults received unnecessary respiratory treatments. In May 2007, he pleaded guilty to three counts of conspiracy and health care fraud charges.
According to medical board documents made public today, Lessler hired recruiters who found patients at board and care facilities in Orange County from 2000 to 2006. Recruiters lured them with soda, candy and doughnuts. The lung treatments were provided without supervision at the boarding facilities. Documents say the medical office billed Medicare for the services, even though those services were not provided in the doctor's office, as required by Medicare.
Lessler, 70, agreed to give up his license and signed an agreement with the medical board to do so in July. Santa Ana attorney Raymond McMahon, who represented him in the proceeding, is on vacation and could not be reached for comment.
Federal records indicate Lessler was to be sentenced last month, but the computer system does not indicate the disposition. Neither his defense attorney nor prosecutors could be reached late today.
According to U.S. Attorney Patrick Fitzgerald's office
Cardiologist charged with health care fraud
Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement ...
49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.
CHICAGO -- Federal authorities have charged a cardiologist from the southern Chicago suburbs with bilking Medicare and insurance companies out of more than $13 million for care they say he never provided.
According to U.S. Attorney Patrick Fitzgerald's office, 49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.
Fitzgerald's office alleged Friday that Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement for high levels of cardiac care that the office says the doctor never performed.
Sheth allegedly used his hospital access to obtain patient information.
Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement ...
49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.
CHICAGO -- Federal authorities have charged a cardiologist from the southern Chicago suburbs with bilking Medicare and insurance companies out of more than $13 million for care they say he never provided.
According to U.S. Attorney Patrick Fitzgerald's office, 49-year-old Dr. Sushil Sheth faces up to 10 years in prison and a $250,000 fine for one count of health care fraud.
Fitzgerald's office alleged Friday that Sheth received $13.4 million between January 2002 and July 2007 in fraudulent reimbursement for high levels of cardiac care that the office says the doctor never performed.
Sheth allegedly used his hospital access to obtain patient information.
Wednesday, January 21, 2009
Wachovia recommended that CHS take part in a securities-lending program. 2003
CHS determined that the securities-lending program was proving too risky,
Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” Investments
Posted On: January 19, 2009 by Shepherd Smith & Edwards
Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” InvestmentsCarolinas Healthcare System (CHS) is suing Wachovia Corp for alleged bad investments that resulted in losses valued at over $19 million. CHS is also accusing the bank of “directly misleading” it, misrepresenting the risks associated with the investments, and failing to follow the hospital system's orders that it be withdrawn from the securities-lending program. Wachovia spokesperson Mary Eshet says that the company disagrees about the allegations, was always in compliance, and only made appropriate investments for CHS.
In 2003, according to the investment fraud lawsuit, Wachovia recommended that CHS take part in a securities-lending program. As a participant, a third party would borrow securities from CHS's portfolio in return for collateral that would be invested by Wachovia until the securities were returned. This would also hopefully result in additional returns.
Per the agreement, Wachovia was only supposed to invest in safe, liquid, quality securities. Any time CHS opted to withdraw from the program, the hospital system was supposed to get all of its investments back within five business days. Also, Wachovia would be allowed to keep 40% of the profits on one account and 35% on the other account.
Last summer, CHS determined that the securities-lending program was proving too risky, especially with the markets collapsing. In September, CHS notified Wachovia to return all borrowed securities right away.
Wachovia couldn’t return all of the securities immediately. Wachovia had invested for CHS $14.9 million in Sigma Finance Corp-issued floating rate notes (now worth $750,000) and $5 million in Pricoa Global Funding floating-rate notes (now worth $4.95 million).
The lawsuit contends that Wachovia never notified Carolinas HealthCare System that the investments were not appropriate until CHS decided to end its participation in the securities-leading program. 5 days after Sigma went into receivership last October, Wachovia told the hospital system for the first time that its investment was, at that time, worth just $1.8 million. CHS says there is no market for the Pricoa notes.
CHS contends that Wachovia gained 40% of the profits but did not suffer any of the losses. The hospital system is solely responsible for returning the lost collateral to its securities borrowers.
CHS sues Wachovia over investment advice, Charlotte Observer, January 15, 2009
CHS files suit vs. Wachovia over losses on investments, Charlotte Business Journal, January 9, 2009
Related Web Resources:
Carolinas HealthCare System
Wachovia Corp
Call or e-mail Shepherd Smith Edwards and Kantas LLP today.
Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” Investments
Posted On: January 19, 2009 by Shepherd Smith & Edwards
Wachovia Corp Sued by Carolinas Health Care System for More than $19 Million in “Bad” InvestmentsCarolinas Healthcare System (CHS) is suing Wachovia Corp for alleged bad investments that resulted in losses valued at over $19 million. CHS is also accusing the bank of “directly misleading” it, misrepresenting the risks associated with the investments, and failing to follow the hospital system's orders that it be withdrawn from the securities-lending program. Wachovia spokesperson Mary Eshet says that the company disagrees about the allegations, was always in compliance, and only made appropriate investments for CHS.
In 2003, according to the investment fraud lawsuit, Wachovia recommended that CHS take part in a securities-lending program. As a participant, a third party would borrow securities from CHS's portfolio in return for collateral that would be invested by Wachovia until the securities were returned. This would also hopefully result in additional returns.
Per the agreement, Wachovia was only supposed to invest in safe, liquid, quality securities. Any time CHS opted to withdraw from the program, the hospital system was supposed to get all of its investments back within five business days. Also, Wachovia would be allowed to keep 40% of the profits on one account and 35% on the other account.
Last summer, CHS determined that the securities-lending program was proving too risky, especially with the markets collapsing. In September, CHS notified Wachovia to return all borrowed securities right away.
Wachovia couldn’t return all of the securities immediately. Wachovia had invested for CHS $14.9 million in Sigma Finance Corp-issued floating rate notes (now worth $750,000) and $5 million in Pricoa Global Funding floating-rate notes (now worth $4.95 million).
The lawsuit contends that Wachovia never notified Carolinas HealthCare System that the investments were not appropriate until CHS decided to end its participation in the securities-leading program. 5 days after Sigma went into receivership last October, Wachovia told the hospital system for the first time that its investment was, at that time, worth just $1.8 million. CHS says there is no market for the Pricoa notes.
CHS contends that Wachovia gained 40% of the profits but did not suffer any of the losses. The hospital system is solely responsible for returning the lost collateral to its securities borrowers.
CHS sues Wachovia over investment advice, Charlotte Observer, January 15, 2009
CHS files suit vs. Wachovia over losses on investments, Charlotte Business Journal, January 9, 2009
Related Web Resources:
Carolinas HealthCare System
Wachovia Corp
Call or e-mail Shepherd Smith Edwards and Kantas LLP today.
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