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Pair sentenced to prison after committing $50 million of medical fraud, unnecessary procedures


Mail fraud

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(NaturalNews) Not all physicians are unethical, but the growing trend of fraud being committed by the conventional medical industry in the United States makes it imperative that patients remain vigilant, ask questions and refrain from putting blind trust in anyone charging you a fee.

A report from Courthouse News Service noted that a pair of Southern California women were recently convicted of mail fraud and will face decades in prison after pleading guilty to swindling insurers out of $50 million worth of medically unnecessary surgeries.

"Theresa Fisher, 45, of Tustin was convicted of five counts of mail fraud and Lindsay Hardgraves, 30, of San Pedro was convicted of two counts of mail fraud after a six-day jury trial," the news service reported.

A press release from the FBI further stated that the medically unnecessary procedures were performed on patients in exchange for "free or discounted cosmetic surgeries."

"A large number of the fraudulent claims were submitted to the International Longshore and Warehouse Union and Operating Engineers Union health insurance plans. Other victim insurers included Aetna and Anthem," the FBI press release stated.

Going away for decades

Additional reports noted that Hardgraves would lure patients to a surgery center in Orange, California, while Fisher, a "consultant" there, would schedule the procedures after coaching patients "to fabricate or exaggerate symptoms so that their medical procedures would be covered by their insurance," federal prosecutors stated.

The surgery center was known alternately as Princess Cosmetic Surgery, Vista Surgical Center and/or Empire Surgical Center, Courthouse News Service reported.

The FBI's press release further stated:

Marketers such as Hardgraves referred "patients" to the surgery center, where they were told they could receive free or discounted cosmetic surgeries if they underwent multiple, medically unnecessary procedures that would be billed to their union or PPO health care benefit program. Fisher was a consultant at the surgery center who scheduled procedures after telling the "patients" about the free cosmetic procedures they could receive and coaching them to fabricate or exaggerate symptoms so that their medical procedures would be covered by their insurance.

The FBI further noted that the procedures that were typically performed on "patients" were endoscopies (EGDs), colonoscopies and cystoscopies. Once insurance companies paid the claims, the same patients were then provided free or dramatically discounted "tummy tucks," breast augmentation surgeries and liposuctions. Sometimes the surgery center would just bill the cosmetic procedures, like tummy tucks, as though they were medically necessary (as in hernia surgeries).

The pair will be sentenced in federal court May 29. They each face a statutory maximum sentence of 20 years in prison for each count of mail fraud. Fisher was found guilty on five counts of mail fraud; Hardgraves on two counts.

Government insurance program fraud is also rampant

"This case is the product of an ongoing investigation by the Federal Bureau of Investigation, the United States Department of Labor - Office of Inspector General, the United States Department of Labor - Employee Benefits Security Administration, and the Office of Personnel Management - Office of Inspector General," the FBI said.

In a separate info page, the FBI said the sheer size of the insurance industry, with 7,000 companies collecting more than $1 trillion in premiums annually, makes it a lucrative target for fraud.

"The total cost of insurance fraud (non-health insurance) is estimated to be more than $40 billion per year. That means Insurance Fraud costs the average U.S. family between $400 and $700 per year in the form of increased premiums," the FBI's info page online stated.

Defrauding government (taxpayer) programs is also lucrative - and common. According to the Department of Health and Human Services in a May 2014 announcement, a sweeping Department of Justice operation took down 90 individuals, "including 27 doctors, nurses and other medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $260 million in false billings."

"Medicare is a sacred compact with our nation's seniors, and to protect it, we must remain aggressive in combating fraud," said Attorney General Eric Holder, following the arrests.

Sources:

http://www.courthousenews.com

http://www.fbi.gov

http://www.hhs.gov

http://www.fbi.gov

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