"It raises medical costs for everyone:" How Medicare fraud impacts your medical bills
RALEIGH, North Carolina — It is one of the most common types of health care fraud. You get one procedure done, but the doctor, clinic or company bills for a more expensive one. It's driving up the cost of health care and we're all paying the bill.
“A very complicated, complex procedure is billed to Medicare to generate a higher payment to the provider," explained U.S. Postal Inspector Michael Carroll.
It's a growing problem as more and more people live longer and are on Medicare.
“What that ultimately does is it raises medical costs for everyone. In essence, every single person in this country is a victim of this crime,” Carroll said.
One couple, Donald and Shirley Blaine, cheated the system when the husband and wife duo formed a company called Respa-Test.
Donald Blaine (left) and Shirley Blaine (right)
“They were claiming they were doing these very complicated sleep studies, which would require overnight monitoring of oxygen, and heart rates, and things like that by a doctor and a staff,” recalled Carroll.
Turns out, the Blaines weren't performing anything in their offices of that magnitude.
“Our investigation showed that the procedures that were actually completed in the office were very simple procedures — low cost procedures that might be billed to Medicare for $3 or $5,” Carroll said.
Even though the procedures were low-cost, the Blaines would charge Medicare close to $500. A practice like this effects everyone.
"Everyone’s premiums, everyone’s costs, everyone’s insurance costs, medical costs go up as a result of a fraud like this," Carroll said.
There's a simple way to ensure a doctor, clinic or business isn't altering costs — keep a close eye on your medical and insurance bills.
"If you go to the doctor for a relatively simple procedure and you see something that appears to be much more complicated billed or your explanation of benefits appears to be much higher price than what you think it should have been billed at, then you need to call the insurance company," Carroll advised.
Donald and Shirley Blaine both pleaded guilty to charges in connection with the scam. They were sentenced and ordered to pay $5 million in restitution.