The most basic case of fraud.
Healthcare fraud happens all the time but the most classic case of fraud is charging for something and not performing the service. Let’s look at the at the recent arraignment of Primera healthcare executives in Atlanta Georgia. Tim Darnell from the ATL based paper patch writes in his article, “Primera Medical Group Execs Charged With Healthcare Fraud”
The CEO and COO of Atlanta-based Primera Medical Group have been arraigned on federal charges that they submitted more than 4,500 fraudulent claims for allergy treatments. CEO Shailesh Kothari and COO Timothy McMenamin have been charged for their alleged roles in the scheme, in which prosecutors say they sought more than more than $8.5 million in insurance payments after submitting the claims.
According to prosecutors, Primera Medical Group was a health clinic in Atlanta that focused its practice on preventative wellness, specifically corporate wellness, concierge care, and allergy testing. Kothari is a doctor of chiropractic medicine who was licensed to practice in Georgia since January 2009.
Primera Medical Group hired market research companies across the U.S. to recruit patients to participate in allergy testing. Patients were told that there would be no out-of- pocket expenses and that their insurance would cover the costs, in addition to being paid $65 to $100 for participating in the test.
As of July 2016, Primera Medical Group allegedly billed insurers for hundreds of blood tests that were not completed. When an insurance company requested records to support the bills, Kothari allegedly asked McMenamin to create false laboratory reports to submit to the insurance company. McMenamin allegedly created the false reports and sent them to the insurance company.
This is the easiest case of fraud out there. Not every case of fraud or negligence is so cut and dry. In order to navigate these murky waters let Patient Options help protect you legally from these issues.
Thanks to the Patch and Tim Darnell for Primera Medical Group Execs Charged With Healthcare Fraud