MEDICAL REVIEWS: SEARCHING FOR NEEDLES IN THE HAYSTACK By Adolpho Nunez-Guererra, M.D. Last night, taking a break from the never-ending stack of …
Medical
February 20, 2014
Mutual of Omaha began taking a special look at medical claims being presented on behalf of employees at the MGM Grand Hotel …
February 20, 2014
It was Code 90844 that heavily figured in the guilty verdict. To bill this level of service, a psychiatric patient must be …
February 19, 2014
In a survey of 169 medical doctors (Archives of Internal Medicine), 73 percent said they would lie to get treatment for a …
February 18, 2014
VOLUNTEERED: $285,000 BIG ONES A Roxbury hospital has agreed to pay more than $250,000 in restitution to the state’s Medicaid Program, to …
February 18, 2014
Clinique Cam Thach, a Westminster, CA, cosmetic surgery clinic, was run by Elizabeth Cam Thach Thi Le. The clinic did big business …
February 18, 2014
NEW ORLEANS, LOUISIANA NOVEMBER MBER 13-16, 1994 By Susan E. Clarke Meeting the Challenge of Change was the theme for this years …
February 18, 2014
By Paul Bigley In recent years we have seen a tremendous increase in “double-dipping,” and in many cases even “triple-dipping,” with regard …
February 15, 2014
It was truly a family affair, and an astounding one at that! Mom is Diane Jackson, owner of a home health care …
February 15, 2014
SOME CROOKS ARE DOCTORS; SOME DOCTORS ARE CROOKS By Michael J. Stahl, D.C. Stephen M. Foreman, D.C. Real doctors are often asked …
November 26, 2013
TOO JUICY FOR JUST A GOTCHA The woes of Ophthalmologist (oops, make that now FORMER Ophthalmologist) Joseph Mermelstein began almost ten years …
November 26, 2013
FILE THIS IN THE “STUFF I NEED TO KNOW” BOX Each facility will have a list of approved acronyms, abbreviations, and symbols. …
November 26, 2013
PLAYING FOOTSIE WITH MEDICARE Straight out of Guilford, Connecticut, we have Podiatrist Richard Sockoff, oops, we mean Sokoloff, who has plead guilty …
November 26, 2013
SLASHING THROATS FOR THE SAKE OF PROFIT It is a story of secret recordings, bloodcurdling accusations, and exactly how far a for-profit …
November 26, 2013
Healthcare? Worker’s comp? Auto accidents? Slip and falls? Insurers survive and thrive because of their ability to sort the valid from the …
November 25, 2013
“TWAPPED BY A TWITTER” It was a rather cool case of working together — and Wanda Lee Ann Podgurski’s twittered taunt of …
August 19, 2013
IT AIN’T OVER UNTIL THE DOCTOR SINGS They got the pharmacist, “Bob” Patel, RPh, and handed down a Federal District Court sentence …
August 19, 2013
MEDICAL NOTES HAVE A LANGUAGE ALL THEIR OWN. The Joint Commission for Accreditation of Healthcare Facilities requires that each facility maintain a …
August 1, 2013
WHEN THE SCALES OF JUSTICE ARE WOEFULLY UNBALANCED A retired-after-31-years-in-the-National- Guard-reservist is going to have three and a half years behind bars …
August 1, 2013
Healthcare? Worker’s comp? Auto accidents? Slip and falls? Insurers survive and thrive because of their ability to sort the valid from the …
August 1, 2013
DEFINITELY NOT THE SMARTEST CRACKER IN THE BOX Dauphin County, PA, has an estimated population of 270,000. These Harrisburg area residents include …
The arrest took place in December, 2011, but the matter reached the preliminary hearing stage a year later. The accused, Carlos Guzmangarza …
March 18, 2013
Marcus and Beth Jenkins of Farmington Hills, Michigan, were doing “better” for quite a few years; now they are doing “worse.” Each …
There are hundreds of medical certifications, degrees, licenses, academies, and (unfortunately) all too many initial combos that combine to spell “I-G-O-T M-Y …
First Arrest Made In New Bwc Out-Of-State Investigation – “Operation Interstate” Crosses State Lines
January 24, 2013
Operation Interstate is an ongoing five-month investigation taking place in 11 states and involving 18 Ohio Bureau of Work Comp fraud investigators …
January 15, 2013
If Fall River psychiatrist Kennard Kobrin were to lay down on his own couch and relate his problems, it would take a …
Hundreds, no make that thousands, of people gave a vial of blood in exchange for $30. Upon delivery of each blood sample …
January 13, 2013
Just head on over to the Philippines. Proceed to Manila, then to a particularly dingy section of Recto Street. While you enjoy …
January 13, 2013
So maybe it was an unusual situation to begin with, but the government’s handling of the matter was even more unusual. A …
January 13, 2013
Jackson Memorial Hospital was hit by a plague. Something in the air was causing many of the workers to suffer from symptoms …
January 7, 2013
After the lack of an Oops, I must have made a teeny-weeny billing error defense, Newton psychologist Lionel Lyon has been ordered …
Anne Marie Fangonilo of Redwood City, California, was employed as a claims adjuster for the California State Automobile Association. Her job included …
January 3, 2013
Numerous complaints were received from private insurance carriers by the San Diego Division of the FBI, as well as other FBI offices, …
Alan D. Bersin, United States Attorney, and William D. Gore, Special Agent in Charge, San Diego Division of the Federal Bureau of …
January 3, 2013
“You’re in Good Hands When You Help Out Your Good Neighbor” ought to be the motto for the recent team effort …
January 3, 2013
It was a paper accident scam that bilked insurance companies out of more than $2 million. And it worked for a while. …
January 3, 2013
Staging automobile accidents and filing false medical claims got Gabriel and Amihan Gonzalez tickets to prison and some hefty fines. After pleading …
January 3, 2013
By Michael Z. Lighthouse For special investigative personnel charged with educating claims employees, a lesson in back injuries is a good idea. …
By D. J. Osborne “Can you imagine making a year’s income in a month’s time? Would you like to know how to …
Thirteen people were indicted by a federal grand jury for operating bogus medical clinics to treat bogus injuries from bogus automobile accidents. …
January 2, 2013
On a recent trip to “Nawlins” (as anybody who knows anything pronounces it), I had the opportunity to sit down face-to-face with …
January 2, 2013
Physicians are frequently placed on a social pedestal by most segments of society. As patients, we are at our most vulnerable when …
Philadelphia District Attorney, Lynne Abraham, United States Attorney, Michael Stiles and Postal Inspector In Charge, Bruce Chambers, announced the return of a …
December 31, 2012
Patient has chest pain if she lies on her left side for over a year. On the second day the knee …
RIVERSIDE Investigators from the California DOI Fraud Division and the Riverside DA’s office arrested 23 medical professionals and office personnel and raided …
December 31, 2012
By Shirley Eileen Fitzgerald, RN Consider the case of Mr. Myers, a 45-year-old, white, male executive, hospitalized following an important business lunch …
December 31, 2012
In one of the largest crackdowns on insurance fraud in the state’s history, Florida insurance fraud investigators went looking for 63 suspects …
December 31, 2012
By Barry Zalma The story that follows is based on fact. The names, places and descriptions have been changed to protect the …
December 30, 2012
Orange County District Attorney Michael R. Capizzi announced that a Garden Grove physician has been convicted of insurance fraud and conspiracy to …
December 30, 2012
Already the fastest growing part of the Medicaid-funded health care system, state and federal outlays in the home health industry have ballooned …
December 30, 2012
While the vast majority of health care providers are honest, health care is a big business; and big business without regulatory and …
December 30, 2012
Physical Therapy: Terms and Definitions Accepted Standard of Practice The following documentation requirements constitute the accepted standard of practice in providing physical …
The Florida Board of Medicine has been cracking down on doctors recently. Dr. Taj Pal Singh Jowhal has had his medical licensed …
December 30, 2012
Combining the talents of investigators from the California Department of Insurance, the Los Angeles County District Attorney’s Office, the National Insurance Crime …
Corning Clinical Laboratories, a New York-based corporation, reported revenues of $1.6 billion in 1995. The government is now going to take a …
December 29, 2012
Just over two years ago, in June 1994, National Medical Enterprises, headquartered in Santa Monica, California, pleaded guilty to seven felony …
December 29, 2012
In 1994, David E. Sloane was arrested in a federal grand jury investigation of insurance and mail fraud. In all, 17 …
Sadly, the Following Story is Non-Fiction Fraudulent Cancer “Cure” Attracts Desperately Ill Patients
December 29, 2012
By Shirley Eileen Fitzgerald, RN Ten days before his death, at the peak of his career, Ken was an extremely bright, vibrant, …
December 29, 2012
Charles Dodge was his name. Hospital Indemnity Plans (HIP) were his game. Dodge was unemployed and had no regular source of income—so …
December 29, 2012
Even the unique courtroom talents of F. Lee Bailey couldn’t get a Middleburg Heights doctor exonerated of charges that he bilked medical …
By Barry Zalma Recently the Fraud Bureau arrested a young woman in Los Angeles County for operating an insurance fraud school. …
December 28, 2012
On February 1, Orange County, California, District Attorney Michael R. Capizzi announced the unsealing of nine grand jury indictments against 20 suspects …
December 28, 2012
By D. Michael Bush In Los Angeles, an insurance company recently filed suit against a group of lawyers and doctors who were …
There are two little words that strike terror into the collective hearts of less than ethical New Mexico health care providers. T …
December 28, 2012
By Susan E. Clarke Staff Writer An article in the May 1995 issue of the Journal of Hand Surgery discussing the Australian …
December 28, 2012
The case brought to light in the Gotcha column (John Cooke Fraud Report, September/October 1995 issue) about the taxi driver who …
December 28, 2012
Modality Billing Codes 97010 hot or cold packs 97012 mechanical traction 97014 electrical stimulation (unattended) 97016 vasopneumatic devices 97018 paraffin bath 97020 …
December 28, 2012
By Susan E. Clarke Helpful information — information that will assist the fraud-fighting professional — is often available if you just know …
December 28, 2012
Is turnabout fair play? Are some con games okay, depending only on who’s getting taken advantage of? Say hello to Bruce Gordon, …
December 28, 2012
Lloyd Mitchell Weaver Jr. thought he would die before they caught up with him — so why die poor when he could …
December 28, 2012
By Leslie Kim Health care fraud is not new. Companies have recognized its existence for many years. Until the late 70’s the …
December 28, 2012
Important new guidelines issued by a federal agency study group provide powerful ammunition for insurers fighting against over treatment for lower …
December 28, 2012
A July 19, 1995, draft audit by the General Accounting Office leaves First American Health Care with a lot of explaining to …
December 28, 2012
Hugh Clarence Johnson: pilot, Vietnam veteran, former president of two veteran’s associations and the Cotati Chamber of Commerce, member of numerous …
December 28, 2012
California regulators called it the biggest case of workers’ compensation fraud in the state’s history. James Eisenberg, a Santa Monica physician, and …
December 28, 2012
Insurance Fraud Charges Levied Against UCI Clinic Or “I’ll Have 2 Poached Eggs To Go” By Susan E. Clarke With the many …
December 28, 2012
Thelma Bowman, a former personnel supervisor for the city of Los Angeles, seemed to have it all—a big, new home, a nice …
December 28, 2012
A Northbrook, Illinois-based health care services company has pulled its hand out of the cookie jar so that it can write some …
December 28, 2012
By Eric Tackett, 1994 Published by Laser Tech Finally, a neat, complete, well-written manual that walks the reader through the complicated world …
By Judy Dennis When a patient has a back injury, it is sometimes difficult to tell from the report what the doctor …
December 28, 2012
By Barry Zalma In 1990 Moshe Ben-Moshe and Menashe Ben-Moshe started a course of conduct that led to their recent arrest …
December 28, 2012
You are a health care insurance executive. You suspect your company is being ripped off by certain medical professionals, or policyholders, or even your …
December 28, 2012
Two California attorneys were among four people arrested last month on suspicion of felony insurance fraud. The two attorneys, Conrad Salumbides of …
December 28, 2012
By Susan E. Clarke California attorney Robert Standard – who was convicted of five felony counts on September 6, 1994 – …
After a cautious and rigorous analysis of national malpractice claims, Johns Hopkins patient safety researchers estimate that a surgeon in the United …
December 26, 2012
Three cheers for the Seventh District Circuit Court, for doing (04/04) an excellent job of imposing justice. Krishnaswami Sriram admitted in Federal …
December 26, 2012
By Dr. Barry L. Johnson Fraudulent medical schemes are a growing problem in the health and property/casualty insurance sectors. In fact, they …
December 26, 2012
Imagine this scenario. Doctors, “cappers” and board-and-care administrators cooperate to make elderly, infirm and mentally ill patients available to get unnecessary respiratory …