Miami has set up a task force to deal with insurance fraud, and with good reason. In Miami it is a $1 billion dollar industry that is an ethical free-for-all where the biggest losers are you and me.
In the most recent case, the clinic had worked out a bizarre scheme. The Brothers Medical Center has been under investigation since September 2015. Led off in handcuffs earlier this week was the clinic’s physician, his head therapist and a receptionist and administrative person. They have been charged with filing false or fraudulent insurance claims, third-degree grand theft and organized scheme to defraud. This is insurance fraud pure and simple.
Insurance fraud committed on the part of physicians and staff is not a new phenomenon, but this medical center has taken the fraud to a whole new level. The Brothers Medical Center recruited fake patients who were allegedly involved in fake automobile accidents. The patients then came to the center complaining of aches and pains they never had, and then everyone turned around and charged the insurance company.
As suspicions arose, the insurance fraud task force went undercover and apparently had an officer pose as a volunteer patient complaining of nonexistent pains from a nonexistent accident. Apparently, the fake patient tactic has been working quite successfully, because the taskforce arrested eight others from an unrelated clinic just a few days later.
Insurance Fraud: Recruiting co-conspirators
From an ethical standpoint, this is the double-whammy. Not only did the medical center commit insurance fraud, they had to go and recruit dupes to participate in their game. I am certain they probably convinced “the accident victims” that they could not get into trouble. Wrong. The courts are now considering bringing charges against them as well.
There is something doubly insidious about fraudsters recruiting others to play their game, no matter what the “game” might be. In this case, it shows beyond doubt that there is not only a complete lack of ethics in a medical sense, but that there is a complete disregard for the law. Obviously, the medical clinic did not care about the welfare of those they recruited; it was a focus on greed without thought for consequences.
Before discussing possible solutions we must remind ourselves that insurance fraud is far from a victimless crime. We are all victims. Healthcare costs are astronomical, and it is easy to blame everyone from big pharma to physician’s salaries. Ultimately those we must blame for this mess is us. We, as a society, are willing to accept a lack of controls and an almost nonexistent ethical code.
At the very least, we must begin to demand greater accountability within the medical community. As I obviously can’t reach every healthcare provider in the nation, it is not overly self-serving to ask for mandatory ethical training for every level of healthcare profession in this nation, starting with medical billing, medical technicians and chiropractors, moving all the way up the scale to neuro-surgeons and cardiologists.
Second, the training must explain that there will be a set of unwavering consequences. The consequences must be imposed. I am strongly in favor of a loss of licensing for severe penalties plus fines and even jail time.
Third, in cases of proven fraud, the insurance carriers must be reimbursed by everyone involved, even if it also means collecting from the patients themselves. Ultimately, poor ethics costs lives. Patients with true medical conditions but limited resources are being blocked from care by fraudsters stealing from the system. We cannot allow bad ethics to stand in the way of good care.
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