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Howard Ain, Troubleshooter: Crooked Doc

Updated: Friday, January 30 2015, 08:21 AM EST
CINCINNATI (Howard Ain) -- The feds caught up with a couple who ripped off Medicare for millions of dollars.
It turned out that kind of fraud was very common.  It's one of the most common types of health care fraud, a person gets a procedure done but the doctor, clinic or company bills for a more expensive procedure.  It drives up the cost of health care for all who use it.

Michael Carroll, a U.S. Postal Inspector, said, "A very complicated, complex procedure is billed to Medicare to generate a higher payment to the provider."

It's a growing problem as more and more people live longer and are on Medicare.
Carroll continued, "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."
The story began with Donald and Shirley Blaine, a husband and wife duo who formed a company called Respa-Test.
"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," said Carroll.
In reality the investigation showed the procedures that were actually completed in the office were very simple procedures.  They were low cost procedures that might be billed to Medicare for $3 or $5. Postal inspectors said the Blaine's would charge Medicare close to $500.
"Everyone's premiums, everyone's costs, everyone's insurance costs, medical costs go up as a result of a fraud like this," Carroll said.
Some advice from postal inspectors:  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," advised Carroll.

The Blaine's eventually pleaded guilty prior to their trial. They were sentenced and ordered to pay $5 million in restitution.

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Howard Ain, Troubleshooter: Crooked Doc

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