Crooks defraud health care system with fake insurance plans and phony Medicare, Medicaid claims

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Jul 8 2010

CNN Money: "Massive unemployment and a changing health care system is creating a breeding ground for con artists." Fake health insurance is one of the "fastest growing scams." Advertisements for such products are "stapled to neighborhood telephone polls, flyers left on your car or maybe you'll get a phone call from someone who's selling health insurance at extremely low rates, as low as $29.99 a month in some cases, says Jim Quiggle of the Coalition Against Insurance Fraud. The sad truth is that often these bogus policies pay little or nothing on claims, leaving consumers with exorbitant medical bills" (Haley, 7/6).

Meanwhile, CNN's Dr. Sanjay Gupta investigates and interviews health care fraud investigator Harry Markopolos, who explains how easy it is for people to overcharge for medical procedures to defraud the system (7/5).

In other health care fraud news, The Examiner reports that Idaho's attorney general "has recovered $106,648.90 in a legal settlement with a drug manufacturer, Alpharma Incorporated. A suit against Alpharma alleged that they [made] false or fraudulent claims for the prescription drug Kadian. The claims for the drug, which is a sustained release morphine sulphate for pain management, were submitted to the Medicaid program between January 1, 2000 and December 29, 2008. In the suit, Idaho accused Alpharma of offering and paying for training programs, consulting forums, research grants, speakers bureaus and made false statements about the safety and efficacy of Kadian. All of the actions were done to induce health care providers to prescribe the drug" (McKie, 7/6).

Idaho Reporter: "In total, the drug maker will pay $42.5 million to resolve the fraud claims, with $33.6 million going to the federal government, and $8.9 million to the states. This is the second settlement between Alpharma and the state of Idaho. In May, the attorney general's office announced a $1.2 million deal with Alpharma and another pharmaceutical company to settle false or inflated prices for drugs used in Idaho's Medicaid program" (Iverson-Long, 7/6).

This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.