Fraud Files

December, 2008 - Henderson submitted fake bills to Highmark for numerous chiropractic services that were not performed on patients who cooperated in the crime. During that period, Henderson billed Highmark for $21,409,214.02 and was paid $11,264,854.05.

March, 2007 - The owner of Upper Bucks Chiropractic Clinic. was charged with submitting $90,000 worth of false insurance claims to Highmark and Independent Blue Cross for more than 1,800 procedures, which were not rendered.

In Lackawanna County an investigation revealed that 78 patients were billed for procedures that a chiropractor never administered.– BlueCross, Erie, Nationwide and Highmark – to receive over $440,000 in illegal payments.

January, 2007 - Eleven Charged With Health Care Fraud: Announcement by Gregory W. Anderson, Vice President of BlueCross BlueShield of Michigan. The above-named beneficiaries received cash for signing and filling out documentation indicating that he or she received therapy when, in fact, no therapy services were provided. Medicare and BlueCross BlueShield were defrauded in excess of $300,000.

Dr. Stokes was upcoding surgical procedures and then billing for follow-up visits for post-operative infections that did not exist. BlueCross BlueShield of Michigan estimated that he fraudulently charged at least $500,000.

Detroit doctor and his medical biller treated BlueCross BlueShield cards like ATM cards, attempting to bilk the nonprofit health insurer out of more than $750,000.

Harrisburg, Pennsylvania - criminal charges against two sisters accused of switching identities to secure nearly $30,000 in medical insurance coverage for a surgical procedure performed at a Philadelphia hospital.

July, 2008 - An anesthesiologist who owned the Pain Management Center based in Hyattsville, admitted to receiving at least $1.75 million as a result of fraudulent billings submitted to Medicare, Medicaid and private carriers between 2000 and 2006 (Washington Times, DOJ).

Long Branch podiatrist has been sentenced to a prison term for billing Horizon BlueCross BlueShield more than $200,000 for medical services he never rendered.

Texas Sam Smith Hill, III, Ph. D, was charged with 15 counts of medical fraud. Hill was billing BlueCross BlueShield and Medicaid for services that were rendered to other individuals. In some instances, dates of service were changed for claims that Hill failed to submit within the 95-day submission period for Medicaid claims. Hill has been paid $1,317,928.56 by Medicaid for the time period 2001 to present. The alleged fraud amount identified is $668,739.42.

Blue Cross of Idaho was billed more than $13,252 for emergency surgery and the related hospital expenses for Pratt's surgery. When Blue Cross discovered Pratt had impersonated Willets' soon-to-be ex-husband, it denied the claims.

July, 2008 - Dentist Sentenced for Scheme to Over-bill Medicaid and Insurance Companies. In Abingdon, VA., Dentist Roy Silas Shelburne over-billed insurance carriers and Medicaid for services that were never performed and for services that were performed, but not medically necessary. Patients who Shelburne falsely billed were low income, underage patients who were Medicaid recipients. According to evidence presented at trial, Shelburne "upcoded" the bills for some of his patients.

Maryland Doctor Sentenced for Defrauding Health Care Programs Evaded $781,193. Okafor defrauded health benefit programs by filing false claims for reimbursement from Medicare by billing for hospital services that Okafor did not render and, in many instances, when Okafor was on vacation or not even present in the hospital.

Thieves stealing health care. Sullivan stole the acquaintance's benefits information and pretended to be him, racking up more than $146,000 in hospital bills over seven months before he was caught.

The Philadelphia region's top health insurer, Independence Blue Cross estimates that 30 of the 67 suspected fraud cases it referred to law enforcement this year involving medical identity theft included people who knowingly let someone else use their medical benefits, Stoolman said.

Dale A. Theberge, 44, of 40 Turnpike Road pleaded guilty to fraudulently billing Medicare and BlueCross BlueShield of Massachusetts for physical therapy treatments she wasn't licensed to perform, or allowed to charge for. The loss was $128,000.

Illinois - A Springfield allergist's medical practice would pay $2.8 million in federal fines and compensation to victims of a billing fraud scheme under a proposed agreement filed in court Friday.

A Newport News chiropractor was sentenced Friday to a year and a day in prison and ordered to pay more than $106,000 in restitution for bilking health care companies. He was charged with submitting bills for work he never did to Aetna Inc., Anthem BlueCross BlueShield.