Health Insurance Companies Defraud Medicare and Medicaid

Health insurance companies defraud Medicare and Medicaid. The total amount that health insurance companies should pay for defrauding Medicare and Medicaid is $4,319,180,879 billion. The insurers have settled with the government for only $1,502,300,000 billion (34% of total fraud amount). The government settled at an average rate of 45% of the total amount defrauded. Total amount that was pocketed by the insurers (unrecovered) is $2,816,880,879 billion.  This is all found via public records. The amount of money in some recent cases that has been unreported (sealed by Judge) is probably a high amount as well and probably would greatly inflate the total amount I was able to find.
Amerigroup
—————-
Actual amount of Fraud:      $524,700,000
Settlements:                           $225,000,000
% Settled for                           42%
—————————————————————-
 Blue Cross Blue Shield
Actual Amount of Fraud        $522,180,879
Settlements:                            $302,100,000
% Settled for                            57%
 ———————————————————————————–
CareMark
Actual Amount of Fraud:        $110,000,000 million
Settlements:                           $54,200,000 million
 % Settled for                         49%
 —————————————————————————–
Cigna
Actual Amount of Fraud       $74,500,000
Settlements:                           $58,000,000
% Settled for                           77%
 ————————————————————————–
 Humana
Actual Amount of Fraud       $311,800,000
Settlements:                           $155,500,000
% Settled for                           50%
——————————————————————————–
 Medco
Actual Amount of Fraud:       $430,000,000 million
Settlements:                            $155,000,000 million
% Settled for                            36%
 —————————————————————————-
 UnitedHealthcare /Pacificare
Actual Amount of Fraud       $1,300,000,000 billion
Settlements:                                  $97,500,000 million
% Settled for                          7%
 —————————————————————————-
WellCare
Actual Amount of Fraud:         $1,046,000,000 billion
Settlements:                              $455,000,000 million
% Settled for                              43%
—————————————————————————
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Total Fraud                                                               $ 4,319,180,879
Settlements                                                               $1,502,300,000
Average % of total fraud amount Settled for:  45%
Insurers Pocketed:                                                  $2,816,880,879
———————————————————————————————————————–
Sources:
American Medical Association
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
U.S. Department of Justice
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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