Twelve Blue Cross and Blue Shield plans, working with the F.B.I., said Friday that they had broken up an elaborate insurance scheme in which thousands of patients from 47 states were sent to California to undergo unnecessary surgical and diagnostic procedures, for which doctors filed more than $1 billion of fraudulent insurance claims.
Insurance executives and law enforcement officials said that surgery clinics in Southern California typically paid recruiters $2,000 to $4,000 for each patient who received a medical procedure. The patients, they said, received rewards in the form of cash or discounts on cosmetic surgery.
Daniel M. Martino, acting chief of the health fraud unit at the Federal Bureau of Investigation, said the payments to patients ranged from $200 to $2,000 each.
Mr. Martino said the outpatient surgery clinics had billed more than $1.3 billion for services provided as part of the scheme, while insurers and employers had lost $350 million in claims paid to date.
One scheme, $1.3 billion in fradulent billings. Just for comparison's sake, the total amount of all medical malpractice judgements and settlements paid in 2003 was $4.2 billion. But it's the lawyers' fault. Naturally.
(Via Simbaud at King of Zembla.)