Hispanics targeted for use in insurance fraud

[fuzzykitten99]

This story is coming from the Mpls Star Tribune which is the local liberal MSM rag, but it is getting all the facts and no spin, which is very unusual.

The reason I know is because I work for Progressive, and in the office, as well as in the department that conducted the investigation, as well as know the SIU reps that are involved.

Suit accuses clinic of fraud
David Phelps
Star Tribune
Published June 9, 2005

Insurance giant Progressive Casualty Insurance Co. has accused a Robbinsdale chiropractic clinic of fraud by recruiting vulnerable accident victims, overtreating their injuries and filing inflated bills for reimbursement.

A civil lawsuit filed by Progressive says Alivio Chiropractic Clinic targeted illegal immigrants in the Twin Cities Hispanic community for treatment, knowing that the patients would not complain about being billed wrongly for fear of being discovered and deported.

Progressive said its losses exceeded $300,000 and is seeking damages of more than $900,000 through the federal racketeering law that allows plaintiffs to seek an award triple their losses.

The lawsuit alleges that the clinic used "runners" to deliver patients and to act as the go-between with the patients and a personal injury attorney who represented both the victims and the clinic when billing questions arose from the insurer.

Named in the lawsuit are chiropractor Joshua Anderson, Minneapolis attorney Mark Karney, massage therapist Andrea Bongart and office manager Alexis Aguilar. None could be reached for comment.

The suit, filed in federal court in St. Paul, asserts that the clinic sometimes billed for services not rendered and other times provided more treatment than necessary to maximize billings.

Progressive's investigators said the insurer began looking at the clinic about a year ago when routine interviews with patients began to turn up disparities in the treatment they received and what they were billed for.

"As we talked to people who didn't receive the treatment that was billed, we knew we were onto something larger than just a few isolated claims," said Jim Wheeler, major case manager for Progressive's special investigations unit.

Wheeler termed the size of the alleged loss "pretty significant."

The complaint says the runners, sometimes called cappers or steerers, looked in accident reports for victims with Hispanic names. Then they visited the victims at their homes and persuaded them to see the chiropractor. The runners sometimes gave the victims rides to the clinic and acted as interpreters.

Minnesota made it illegal in 2002 for health care providers to use runners to solicit car accident victims for their practices. The lawsuit contends that the runners in the Alivio case remained undetected because the illegal immigrants were frightened to turn them in.

On occasion, when the insurer asked for a second medical opinion for the patient, the capper would brief the patient on what to say and would again provide interpretation.

"If a claimant went outside the members of the scheme," the lawsuit states, "the defendant runner/capper and attorney would threaten the claimant ... and would imply that there could be trouble because of the [immigration] status."

A similar scheme not involving the Hispanic community was uncovered three years ago. A number of chiropractors were punished by the Minnesota Board of Chiropractic Examiners, which revoked or suspended their licenses.

Board director Dr. Larry Spicer said he heard of the Alivio case Wednesday when a reporter called to inquire about any enforcement activities against Anderson. There were none. Spicer expressed frustration that insurers don't always share results of their investigation so that the board, with its limited budget, can discipline chiropractors who might be acting inappropriately.

There's also the issue of a potential criminal case. Wheeler said that when the insurer suspects fraud has been committed, it will refer the matter to authorities.

http://www.startribune.com/stories/535/5447297.html

 

[archangel]

This story is coming from the Mpls Star Tribune which is the local liberal MSM rag, but it is getting all the facts and no spin, which is very unusual.

The reason I know is because I work for Progressive, and in the office, as well as in the department that conducted the investigation, as well as know the SIU reps that are involved.



http://www.startribune.com/stories/535/5447297.html

This is a medicaid scam...has been used in all 50 states..California is the biggest loser in this scam..and the other states are now just feeling the pinch...I say stop this illegal immigration fraud now! Down with the ACLU et al!

 

[dilloduck]

This is a medicaid scam...has been used in all 50 states..California is the biggest loser in this scam..and the other states are now just feeling the pinch...I say stop this illegal immigration fraud now! Down with the ACLU et al!

No illegal immigrants==No scam

problem solved