Health Insurance Companies Medicare Fraud

Health Insurance companies have been getting caught red-handed deliberately defrauding Medicare and Medicaid and other medical organizations for more than a decade. This is all due to insurance execs trying to get as much profit for their shareholders as possible. As a direct result of their felonious behavior,  insurance companies have been fined $2.694 billion for Medicare/Medicaid fraud and $2.435 billion for non-Medicare/Medicaid fraud (overcharging, not paying physicians, slow payments). This comes to a total $5 billion that health insurers have been fined for. The Department of Health and Human Services as well as the Office of Inspector General have officially declared “war” on health insurer fraud and are taking action to make sure this ceases.

Below is a listing of how much an insurer has been fined.

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Aetna

Q1 2012 Revenue: $8.92 billion    (CNBC)

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History of Non-Medicare Fraud:
Fined $750,000         – February 2010
Fined $256,500         – November 2009
Fined $20 million       – February  2009
Fined $5.1 million      – February 2009
Fined $6.25 million   – August 2003
Fined $50,000            – June 2002
Fined $1.4 million      – September 2001
Fined $1.15 million   – November 2001
Fined $1.9 million      – December 2000
Fined $4.5 million       – December 1995
Fined $89 million        – December 1994
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 Medicare Fraud Fines:
Non-Medicare Fines:      $129,546, 500
Total Fraud Fines:        $129,546,500
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AmeriGroup
History of Medicaid Fraud
Fined $225 million        – July 2008
Fined $144 million        – July 2006
Fined $190 million       – July 2006
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Total Fraud Fines:     $559 million
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Blue Cross Blue Shield
BCBS Illinois 2011 Revenue:
BCBS TN       2011 Revenue:
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History of Medicare Fraud:
Fined $25 million   – February 2011
Fined $225,000     – August 2010
Fined $131 million  – April 2007
Fined $1.5 million   – August 2005
Fined $40 million   –  June 2003
Fined $9.3 million  – July 2002
Fined $74 million   –  December 1999
Fined $261 million  – July 1999
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History of Non-Medicare Fraud:
Fined $480,000      – May 2012
Fined $3.7 million – May 2012
Fined $1.5 million   – March 2012
Fined $1.6 million   – February 2012
Fined $325,000       – April 2011
Fined $5 million      – November 2010
Fined $20 million   – September 2010
Fined $95,000    – January 2010
Fined $1 million      –  February  2009
Fined $542,000      – August 2008
Fined $2.1 million  – August 2008
Fined $2.8 million   – March 2008
Fined $1.25 million  – September 2006
Fined $128 million  – May 2006
Fined $23.7 million  – November 2005
Fined $1.5 million      – August 2005
Fined $150,000       – July 2005
Fined $1.8 million   –  December 2003
Fined $135,000      – June 2002
 ———————————————————————————————
 Medicare Fraud Fines:                   $542,025,000
Non-Medicare Fraud Fines:          $194,327,000
 Total Fraud Fines:                          $736,952,000
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CareMark  Advantage
 Q1 2012 Revenue:  $30.8 billion   (CNBC)
 ———————————————————————
 History of Medicare Fraud:
 Fined $5 million         – May 2012
Fined $7.5 million      –  February 2003
 ———————————————————————–
Total Fraud Fines:                $12.5 million
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Cigna
Q1 2012 Revenue:  $6.9 billion (CNBC)
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History of Medicare Fraud:
Fined $24.5 million  – December 2002
Fined $9 million       – March 2000
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History of Non-Medicare Fraud:
Fined $1.2 million  –     April 2011
Fined $20 million    –    February 2009
Fined $97 million    –    July 2007
Fined $150,000      –    January 2006
Fined $540 million  –    September 2003
Fined $80,000         –    June 2002
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Medicare Fraud Fines:            $33.5 million
Non-Medicare Fraud Fines:   $657, 200,000 million
 Total Fraud Fines:                    $690,700,000 million
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First Health Services Corporation
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History of Medicaid Fraud:
 Fined $13 million  –  April 2004
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History of Non-Medicare Fraud
Fined $150 million   –  June 2011
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Total Fraud Fines:         $163 million
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HighMark Inc
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History of Medicare Fraud:
Fined $1.5 million   – April 2004
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History of Non-Medicare Fraud
Fined $10 million   – October 2007
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Total Fraud Fines:       $11.5 million
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 Humana
Q1 2012 Revenue: $10.2 billion
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Breaking News:
 Dept of Justice probing Humana for Fraud –   May 2012  Fierce Healthcare
 Physician Exposes Humana Scam:  WE Jones, MD
 ———————————————————————————————————
 History of Medicare Fraud:
Fined $3.4 million    –  August 2011
Fined $133 million  – October 2005
Fined $8 million       – June   2001
Fined $14.5 million  –  June 2000
Fined $8 million        – November 1999
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 History of Non-Medicare Fraud:
Fined $45,000,000  – May 2012
Fined $314,000     – June 2011
Fined $299,000     –  June 2011
Fined $100,000     –  January 2011
Fined $55,800       – October 2010
Fined $2.8 million  – March 2008
Fined $500,000      – January 2008
Fined $500,000     – August 2007
Fined $4,190,000 million – July 2005
Fined $1,013,259 million – July 2005
Fined $3.5 million   – May 2005
Fined $10.2 million – November 2003
Fined $106 million – October 2003
Fined $78.5 million – January 2000
Fined $10 million    – July 1999
 ——————————————————————–
Medicare Fraud Fines:               $166,900,000 million
Non-Medicare Fraud Fines:      $264,740,859 million
Total  Fraud Fines:                      $431,640,859 million
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Lovelace Health Plan
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History of Medicare Fraud:
Fined $24.5 million  – December 2002
 ——————————————————-
Total Fraud Fines:                    $24.5 million
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Medco Health Solutions
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History of Medicare Fraud:
Fined $29 million  –  April 2004
Fined $115 million – October 2006
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History of Non-Medicare Fraud
Fined $2.75 million  – March 2012
Fined $29.3 million  – April 2004
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Medicare Fraud Fines:            $144 million
Non-Medicare Fraud Fines:   $32,050,000
 Total Fraud Fines:                    $176,050,000 million
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 Rocky Mountain Health Plans
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Fined $1.5 million    –  August 1999
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Total Fraud Fines:     –  $1.5 million
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Tenet Choices Inc
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History of Medicare Fraud:
Fined $8.25 million –  March 2004
Fined $54 million    –  August 2003
Fined $4 million    –  February 2003
Fined $115 million  –  January 2003
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Total Fines:               $177,650,000 million
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 UnitedHealthcare
Q1 2012 Revenue: $27.23 billion (CNBC)
 —————————————————-
History of Medicare Fraud:
Fined $3.5 million –  December 2004
Fined $4 million   –   September 2002
Fined $2.9 million –  November 2000
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History of Non-Medicare Fraud:
Fined $1.3 million  – May 2012
Fined $20 million    – May 2012
Fined $350 million  – October 2010
Fined $457,000       – October 2010
Fined $750,000      – November 2009
Fined $500,000       – August 2009
Fined $50 million    – January 2009
Fined $250,000       – July 2008
June $50,000          – June 2008
Fined $2.8 million   – March 2008
Fined $3.5 million   – January 2008
Fined $4.4 million   – December 2007
Fined $12 million    – September 2007
Fined $650,000      – May 2007
Fined $59,500         – February 2007
Fined $364,750       – March 2006
Fined $350,000      – March 2006
Fined $5,000          – January 2005
Fined $2.8 million – January 2005
Fined $150,000     –  May 2002
Fined $87.3 million   –  April 2002
Fined $35,900       – November 2000
Fined $175,000     – April 2000
Fined $127,400     – March 2000
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Medicare Fraud Fines:            $10,400,000
Non-Medicare Fraud Fines:   $538,024,550 million
 Total Fraud Fines:                    $548,424,550
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 WellCare
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History of Medicare Fraud:
Fined $138 million            March 2012
Fined $80 million             May 2009
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History of Non-Medicare Fraud
Fined $120,000   –  August 2009
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Total Fraud Fines:    $218,120,000
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 WellPoint
Q1 2012 Revenue: $15.42 billion  (CNBC)
 —————————————————-
History of Medicare Fraud:
Fined $6 million       –  October 2005
Fined $198 million  –  July 2005
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History of Non-Medicare Fraud:
Fined $100,000    – August 2008
Fined $1 million   – March 2007
Fined $80 million    – May 2005
Fined $448 million  – July 2005
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Medicare Fraud Fines:             $204,000,000 million
Non-Medicare Fraud Fines:    $529,100,000 million
 Total Fraud Fines:                    $733,100,000
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 Total Medicare Fraud Fines:                    $2,694,475,000 billion
Total Non-Medicare Fraud Fines:           $2,506,958,859 billion
Grand Total Fraud Fines:                           $5,219,493,859 billion
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Sources:
American Medical Association
CNBC
CNN
Center for American Progress
Centers for Medicare and Medicaid Services
Fox Business
MSNBC
Wall Street Journal
Matthew Taber is Chief Operating Officer of Direct Care For Me (www.directcareforme.com), which provides full access to medical care to patients and  100  percent reimbursement to primary care physicians through direct primary care (no insurance necessary) models. Low cost health insurance for business owners and employees. On site health care for employees. Exclusive savings on x-rays, labs, surgery, specialty office visits. See a doctor (family practitioner, internist, ob/gyn, pediatrician) anytime on your smartphone tablet, or computer (telemedicine). Reach him by e-mail at matthew at direct care for me dot com or by phone at 615-669-8347 to sign up today.

About mdtaber

Mr. Taber has a MS and BS in Health Services Administration and has been working in the industry since 1998. Mr. Taber oversees operations, business development, and marketing efforts of the company. In addition, he also acts as government liaison and regularly briefs local, state, and federal government officials on healthcare policy issues. Mr. Taber is a member of the American College of Healthcare Executives.
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