Here is an example of an anesthesiologist claiming to have discovered two massive fraud cases.
A New York anesthesiologist is the driving force behind a pair of lawsuits in trial courts in New York and California involving millions of dollars in what he states are fraudulent anesthesia billing claims.
The anesthesiologist, Berton Forman, MD allege that for years hospitals have been dramatically overcharging patients for anesthesia services- doubling or tripling bills and even charging for general anesthesia when none was provided. Dr Forman says the scope of the fraud could total more than $1 billion nationally.
Dr Forman said a major insurer for whom he conducted a fraud inquiry to detect precisely such misconduct failed to act on his findings out of fear that it would lose the business of preferred provider organizations (PPO). Those companies act as middlemen between anesthesiologists and insurers and according to Dr Forman, forced the latter to sign contracts that prevent them from carefully auditing claims. In returns insurers received discounts, ranging from 10% to 35% from the anesthesia providers in the network, saving that in theory they can pas along to plan members.
The California case involves Sutter Hospitals which has been accused of passing on bogus anesthesia bills to insurers and the two PPOs of taking part in the scheme. Dave Jones, CA Insurance commissioner agreed with the suit and is asking for triple damages for each claim and up to a $10,000 fine per violation. He “believed the amount of the fraudulent charges is in the hundred of millions of dollars in not more.” As a whistleblower, Dr Forman is eligible to receive up to 40%of any money recovered.