Summary

Original source:
http://www.post-gazette.com/pg/05085/477932.stm

Details

• When a dozen insurance companies from around the country filed a lawsuit this month alleging massive fraud at surgery centers in Southern California, it was a milestone for the chief fraud investigator at Highmark, Inc.
• Darrell Sapp, Post-Gazette Thomas Brennan Jr., in the hallway of Highmark's offices at Fifth Avenue Place, Downtown, is the chief fraud investigator for the health insurance giant.
• Thomas Brennan Jr., helped unravel a scam that Highmark says led dozens of its patients, including a few from Pittsburgh, to California for unneeded procedures.
• The patients received several hundred dollars each in a scheme that reaped millions of dollars in insurance reimbursements for the surgery centers, according to the lawsuit brought by Highmark and 11 other Blue Cross and Blue Shield companies.
• "With what's transpired in Southern California, you have individuals who are actually cutting people to justify billing," Brennan said in an interview this week.
• The lawsuit, which was filed March 10 in federal court in Los Angeles, seeks recovery of more than $30 million from nine surgery centers, seven medical management companies and 34 individuals allegedly involved in the "Rent-a-Patient" scheme.
• It allegedly was carried out through paid recruiters who enlisted patients to travel to the surgery centers and undergo needless and sometimes hazardous procedures ranging from colonoscopies to an operation that corrects sweaty palms.
• Brennan recalled interviewing one patient who claimed he underwent a circumcision after being approached by a recruiter in the men's room.
• After the surgeries, the lawsuit claims, the providers submitted fraudulent insurance claims.
• The scheme came to light when some of the patients from Phoenix received insurance reimbursement and kept the money instead of turning it over to the surgery centers.
• When the medical providers sued them, a journalist in Phoenix investigated and exposed the scam in 2003.

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