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OPERATION PATIENT PAYOFF
Stranger than Fiction

04/08/04

Graphic for Health Care FraudThese are the facts: "Scam recruiters" across the country are locating healthy people who have generous health insurance plans...and talking them into traveling to California outpatient surgery clinics to undergo unnecessary and pretty unpleasant surgeries. Things like colonoscopies, adult circumcisions, and sweat glad removal.

What's in it for these "rent-a-patients"? They get airfare, hotel expenses, a cut of the scam profits...and sometimes a little cosmetic surgery thrown in as a bonus.

What's in it for the recruiters and outpatient surgery centers? Big money. The clinics bill the insurance companies for up to ten times the normal cost of these procedures–then split the handsome profits among the doctors and recruiters. Insurance companies estimate they've been hit with over $500 million in claims.

How does the scam work? Recruiters are targeting immigrant populations, soliciting prospective patients through foreign language newspapers, flyers, and word of mouth. They also target specific companies that are known to have generous health insurance plans, looking for likely candidates. And when they've sealed the deal, they coach their recruits on what to say and travel with them to the surgery centers.

Who blew the whistle? Not surprisingly, insurance companies themselves. At meetings of the National Health Care Anti-Fraud Association (NHCAA), dozens of insurance companies complained about this new breed of scam, prompting our Criminal Investigative Division to launch a National Initiative that would focus closely on it. Using data analysis, our joint efforts with NHCAA have connected the dots between the surgery centers and insurance providers–and shown that the scam is deeply entrenched and operating nationwide. Our investigation continues and has intensified in areas throughout the country.

Our advice to healthy prospective recruits? Just say no. It's risky; it's unpleasant; and crime doesn't pay.

Links: White Collar Crime page | Common Fraud Scams