Informants will likely turn out to be physicians deprived of their rightful part of the capitation payment, angry and unable to provide proper medical service. Hopkins recommends that companies beef up their own audit checks. Make sure billing is correct. Make sure no one is receiving money or making improper referrals. Fraud fighter Mahon urges physicians to persuade their medical societies to yank licenses from physicians convicted of fraud.
Boards can write the final chapter on a fraud case.
We can make a dent. We just need the right approach and perspective. All of his columns are accessible through the search function on this site. Pharmacy scams, overbilling and billing for nonexistent patients or unprovided services are only the most obvious forms. His list has been augmented by Joyce Hansen of ReliaStar, a financial service company offering a number of health plans.