Medical board disciplining fewer docs
The coalition has been critical of state medical boards for failing to take action against providers who commit fraud. Our 1998 study found that boards in many states either lacked the funding, authority or willingness to discipline providers who defraud insurance systems.
That study looked at 251 felony convictions in a dozen states and found that many medical boards weren’t even aware the professionals they are supposed to oversee were convicted felons.
Over the 10 ten years, medical boards seemed to be doing a better job in taking action against defrauders. New fraud laws have helped to bring convicted providers to the boards’ attention through mandatory referral requirements. There also is generally a sense that if a provider is cutting corners on the financial side of the practice, patient care may suffer as well.
Now comes a report from the Federation of State Medical Boards that actions against bad docs have declined in each of the last three years. Serious disciplinary actions — including license revocation and suspension — fell 17 percent between 2004 and 2007. No one is offering good explanations for the declines, especially since the number of medical providers increased during that period.
In recent years many states cut back regulatory efforts in an effort to spur business, so perhaps state boards have suffered as a result. And with the recession threatening state budgets, the next few years likely will not be flush times for state medical boards.
Medical boards provide one of the biggest deterrents against fraudulent providers – the loss of their livelihood. Without vigilant oversight, more medical providers will be tempted to cross the line and compromise their ethics. And that will make the job of combating fraud that much harder.
Media and the mind
In the 1994 movie thriller “The Last Seduction,” femme fatale Bridget Gregory comes up with a devious plan to use her new boyfriend to kill her husband and collect a bundle in life insurance. It was a far-fetched plot, but one that so impressed Mechele Linehan of Olympia, Wash. that she decided to try it in real life. Linehan was sentenced to 99 years in prison last week. She admitted to prosecutors that she was inspired by the movie.
A few years ago a Louisiana man was convicted of killing his wife in a fake death scheme gone bad. An accomplice told the FBI that they got the idea from watching an ABC Dateline program that described how easy it is to scam life insurers.
Television (and movies) does influence the human mind. That’s why companies spend billions of dollars each year on TV advertising.
But television is not the only small screen that leaves impressions on people. The computer and video games affect us as well. It’s disturbing that Saints Row, an insurance fraud action game, now has a sequel featuring even more devious scams.
The fraud-fighting community is not winning the battle for the hearts and minds of the American consumer: Consider the high tolerance for fraud and the low public opinion of insurers. Video games and the like make our job that much tougher.
Quote of the week:
“I am running for insurance commissioner because . . . I want to fight insurance fraud, whether by insurance companies and agents or claimants.”
— Candidate Wayne Goodwin in North Carolina in a live blog Q & A session yesterday.
He’s got my vote!
Wives killing husbands for life insurance
The incidence of spouses killing spouses to get their hands on high-dollar life insurance proceeds is all too common. It’s a tragic aspect of insurance fraud that’s no laughing matter.
But I must admit that the video below is funny. Still, let’s hope this doesn’t influence viewers the way the Toyota ads did.
Note: If your server blocks YouTube videos, click here to view this video.
Stupid comp claimant tricks
I’m old enough to admit I don’t know who Hannah Montana is and I’ve never heard her music. But she must be a huge sensation because people are willing to do foolish things to win tickets to her concerts.
The latest contest was a 40-yard dash for men dressed in women’s clothing, sponsored by a Hartford, Conn. radio station. Apparently, one workers comp claimant had nothing better to do one day last October, so he donned a dress, wig and high heels and entered the competition.
When a local tv station covered the drag race, an alert viewer spotted comp claimant Garrett Dalton, 41, and blew the whistle. It took a while, but Dalton, a corrections officer, was finally arrested this week for workers comp fraud. Being branded a cheat is shameful enough. But having your photo in drag plastered about? That ought to send a signal that cheating workers comp just isn’t worth it.
NICB taps former insurance exec as new COO
There’s a new face in the fraud-fighting community this morning. It belongs to Joe Wehrle, former president of USAA Property and Casualty and retired Air Force officer. NICB has tapped him as its new chief operating officer.
This seems to be a strong selection on the part of NICB. General Wehrle has solid management experience in both the military and business. He served as deputy chief of staff for the Air Force overseeing budgeting and training. According to his military bio, he led one of the largest U.S. humanitarian efforts on the African continent, delivering more than two million pounds of critically needed relief supplies to flood-ravaged Mozambique. He served as a master navigator and has logged 120 combat missions and more than 1,800 flying hours.
Wehrle retired from the Air Force in October 2003 and accepted a position with USAA where he led nearly 11,000 employees in six national and two international locations serving five million policyholders. He left USAA in January 2007 when the company restructured its operations.
It’s likely that General Wehrle will be elevated to the top NICB position when current CEO Bear Bryant retires.
General Wehrle’s experience will be needed as NICB seeks to beef up operations and have a greater impact on fraud committed against property/casualty insurers. We look forward to working with him to take fraud fighting to the next level.
Lie detection technology and fraud
England is a longtime user of voice-stress analysis, the system that’s touted to detect when someone strays from the truth. British insurers as well as government agencies have used the technology to question claimants: it detects changes in voice stress, supposedly a reliable indicator of lying.
The technology has its supporters — and critics — on both sides of the Atlantic. There has been little published data to indicate how well the technology works with insurance claimants.
One borough of London recently released data on the first 1,000 disability claimants on which the technology was tested. Of the 1,000 subjects, 43 — or 4.3 percent — were flagged by the system and all of these were found to have filed false claims or displayed a high potential for committing fraud.
Even more impressive: Another 281 claimants withdrew their claims after they learned about the use of the technology. The withdrawal rate is twice what it was before the technology was used.
So users now claim that voice-stress analysis is not only a detection tool, but a deterrent as well.
Officials say no claim is ever denied solely on the basis of voice-stress analysis, but it does help to direct investigators to claims that merit more scrutiny. It’s also said to help speed claims payments to truthful claimants.
So, is America ready for this technology? In an age when cameras catch red-light violators and the FBI can monitor phone calls and e-mail at will, perhaps Americans would accept this technology — if it helps to keep premiums in check.
I’d like to see the results of more thorough testing first.
The latest fraud-fighting heros
Last week was a lucrative one for whistleblowers. Two false-claims cases were resolved — one huge and the other tiny by comparison — with the whistleblowers set to walk away with millions.
The big case involves kickbacks and illegal pricing by mega-pharma conglomerate Merck. The drug company agreed to pay more than $650 million to federal and state governments. Out of that settlement, former Merck employee H. Dean Steinke will receive a bounty of more than $68 million.
The other case involves a hospital in Houston. Employee Robert McCaslin (left) discovered the hospital was billing Medicare for treatment provided to prisoners and patients who had private insurance. He reported his findings to supervisors and was told “that’s just the way we do things here.” As a taxpayer, McCaslin was outraged; he said he couldn’t sleep at night knowing his employer was committing fraud.
He’s probably sleeping soundly these days. He received $3 million of the $15 million the hospital agreed to pay back to the government.
McCaslin seems to be an ordinary guy and a man of few words. But this quiet hero may well inspire others. Asked his plans for the future, he said he’s taking his wife to Paris for Valentine’s Day to recover from the stress of going through a false-claims suit. Good for him and for everyone who refuses to tolerate unethical behavior.
Drilling for dollars
ABC’S Good Morning America gathered a group of victims of Pennsylvania dentist Alireza Asgari for a report that aired Monday. Their stories were gruesome as one by one, they recounted the malpractice Asgari committed on their mouths.
Most of the procedures were not needed. They were performed for the sheer greed of bilking insurers.
Not all doctors and dentists who commit fraud also commit malpractice. But it stands to reason that a medical provider who cuts corners on the business side of a practice probably will cut corners elsewhere — and that includes the quality of care.
Watch the Good Morning America report. More information on Asgari, a 2005 inductee into the Insurance Fraud Hall of Shame, is available here.
NYC school vans insured in Pennsylvania?
Last night Fox News in New York (Fox5 - WNYW) aired an investigative report about a van service for the city school system that appears to be committing underwriting fraud.
Investigative reporter John Deutzman found that vans that transport kids to and from a magnet school in Brooklyn are licensed and insured in Pennsylvania. Deutzman noted that local officials are powerless to do anything about the fraud, but that a state investigation is underway.
Watch the report on the station’s website. It’s very well done. Deutzman, by the way, received an award from the New York Alliance Against Insurance Fraud in 2006 for a great piece on auto underwriting fraud in New York. The fraud-fighting community needs more journalism like this.
Update (January 23) — The guy in the photograph above — along with five members of his family — was charged today with using a Pennsylvania address to falsely obtain driver’s licenses, vehicle registrations and insurance coverage for a total of 14 vehicles, including vans linked to an illegal school bus operation in Brooklyn, NY. The charges were brought by Pennsylvania AG Tom Corbett.