Health care focuses on anti-fraud efforts

Policy experts say the plan to overhaul the health system needs to include a crack down on health care fraud. Local insurance companies and law enforcement groups say they’re pursuing more cases than ever.

Policy experts say the plan to overhaul the health system needs to include a crack down on health care fraud. Local insurance companies and law enforcement groups say they’re pursuing more cases than ever. [audio:100129tefraud.mp3]

The U.S. Attorney in Philadelphia has charged a Montgomery County chiropractor with health care fraud and identity theft. The indictment says that Dr. Neil Hollander billed Independence Blue Cross for more than $900,000 in false claims.

Edward Litchko is senior director of corporate and financial investigations at Independence Blue Cross.

He says the company used data mining software to uncover the alleged fraud, and in some cases Hollander billed the insurance company for more than 24 hours of service in a day.

Litchko: He also had a mobile van that he would drive around the city of Philadelphia and stop in front of office buildings and employees would come out and receive massage therapy, not even chiropractic services and we were billed for again maybe 40, 45, 50 minutes worth of time, when in fact the individuals were in there for maybe 7 or ten minutes.

The company paid out more than $300,000 in claims before the inconsistencies were spotted. Reached by phone Friday, Dr. Hollander decline to comment on the allegations.

The White House and lawmakers hope money recouped from health care fraud will help pay for plans to get more Americans signed up for health insurance. Some estimates suggest that 3 to 10 percent of all health care spending is lost to abuse and fraud.

Litchko says pharmaceutical fraud is on the rise.

Litchko: Individuals may be stealing the health care information of another and then creating false documentation and going into pharmacists and getting prescriptions filled for narcotic drugs that they can then turn around and either use for themselves or sell on the street for a profit.

The chief risk officer at Cigna says that company has noted an increase in organized medical identity theft. Experts say thieves have shifted their attention from banks and mutual funds to insurance companies.