Derby, Preakness & Belmont?
…Not in California.
The Triple Crown of fraud was recently shut down by the California Insurance Commissioner along with the Orange County District Attorney. The scheme impacted more than 13,000 patients and 27 insurance carriers with a $40 Million price tag.
The Triple Crown of scams involved the following “threefer”:
Snake Oil Scam – Non-approved creams costing $15 per tube were billed to workers’ comp carriers for upwards of $700 each. The effects of the creams were unknown, but they came with a $50 per tube physician rebate.
Medication Kickback Scam – Oral pain meds were purchased wholesale, re-packaged, with bar codes modified. Carriers were then invoiced at retail. No disclosure was ever given that the prescribing physician and re-packager had a predetermined profit split per script.
Bogus Urine Test Scam – The fraudsters were nice enough to supply “urine testers” to the offices of the participating physicians. They ordered lots of tests, even when unnecessary, and then sent them to multiple participating labs for excessive testing.
The regulators in California are doing better.
At OMCA, we have our own Triple Crown of protocols to minimize unwarranted expenses:
- Early intervention;
- Scientific evidence;
- Ongoing accountability.
Call us. We can do better.