Though we talk about patient fraud here a lot there is an even bigger problem going on when it comes to cheating the system of workers’ comp. When doctors unfairly bill for their services or even flat out lit about the services they perform in the first place- insurance companies pay more which means you pay more.
One such doctor in California has been accused of billing insurance companies for services she never performed- though they kept paying her as if she did. She would even charge for services to patients that had not been in her office that day. Now that her cover is blown she is being investigated by a slew of agencies like the DA’s office, Department of Insurance, Department of Labor and others.
The reason she became a suspect is because another patient of hers discovered the false charges billed to her insurance. If not for her the insurance companies might not have detected these fake claims for years- if at all. She may or may not lose her license to practice- it will depend on how the case turns out. She might have her license suspended during the investigation, since they think that this one case could turn up evidence of other instances as well.
There are claims systems in place that can catch things like duplicate bills, outrageous charges or procedures that should raise red-flags (such as testing for concussions when a patient sprained their pinkie finger). The problem is that a lot of companies have yet to implement these systems or think they don’t need them. That might be because they might not even know there is a problem in the first place. This doctor was caught, but she leaves behind many others who continue to fly under the radar undetected.