FOUL PLAY

Insurance company mistreatment

News flash: Health insurers participating in public programs like Medicare and Medicaid don’t always have the public interest in mind. A number have been charged with raking in public money for services they never delivered.

The Wall Street Journal reports that a New York investigation uncovered managed care companies charging duplicate premiums and billing for dead and nonexisting patients. In, Florida state and federal agents raided the offices of two HMOs to investigate whether they were really spending as much on mental health services as they reported. And, in 2005, Americhoice of Pennsylvania – now part of UnitedHealth Group – settled with the state over charges it had misled the state about claims, dragged its feet with payment to providers, and denied patients care they had a right to receive.

According to the Journal, traditional fraud prevention for government programs consisted of "policing doctors, hospitals, dialysis centers and the like to catch overcharges or billing for treatment never provided.” Managed care fraudsters. On the other hand, profit by ”shortchanging patients or physicians to cut costs while collecting preset fees from the government," as well as by "refus[ing] to enroll unhealthy people, skimp[ing] on paying doctors or deny[ing] patients care," the Journal reports.

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