Case File #1 Provider submitting claims for services not rendered
A provider was sentenced to 36 months in prison for a $3 million scheme to defraud Independence Blue Cross and seven other health insurance companies. The provider owned a facility and fraudulently billed the insurance companies for treatments that he neither provided nor supervised. The provider hired unlicensed individuals to provide services to patients that were not medically necessary and were cosmetic in nature. The provider then billed insurance companies under his name for these services, billing services in their place that he knew were covered. In addition to the prison term, the provider was ordered to pay restitution of over $1.9 million to the insurance companies.