Special Investigative Unit

Rent-a-Patient Fraud Scheme
Called "Rent-a-Patient" by the FBI, the activity involves providers performing unnecessary diagnostic tests and surgical procedures on patients that have health coverage and then billing the insurance companies - and other types of medical plans - for the fees related to those procedures. In many cases, it appears that the patients receive a payment from the providers to participate in the program. The scheme has impacted many carriers and other payers and it appears that millions of dollars in unnecessary claims may have been paid to providers participating in the scam. Recently the FBI, the National Health Care Anti-Fraud Association (NHCAA) and over 60 insurance carriers met in Santa Monica to discuss the situation. The leader of GEGA's Special Investigative Unit attended that meeting and obtained valuable information that will assist us in reacting to this situation. GEGA is actively working through the NHCAA and the FBI to identify suspect claims and take appropriate action. This is an industry wide problem, with virtually every large provider of health insurance being affected. Beneficiaries, the "patients", participating in the scheme have been identified in all but seven states and over 1000 facilities are suspected to be somehow involved. According to the FBI, Latino, Vietnamese and Korean communities - for whom English may be a second language - are being targeted most aggressively to act as "patients". The FBI attributes over $1.7 Billion in health care fraud to the "Rent-a-patient" scheme. Using information provided to us by the FBI, we have put together a "profile" of a fraudulent claim as well as "flagged" facilities that are suspected to have submitted a "rent-a-patient" claim. In spite of this we are still maintaining our commitment to pay all claims in a timely manner and adhere to all ERISA and state regulations. This is a very sophisticated scam that often involves many people. One of the bigger challenges of this situation is that some providers and facilities may be submitting fraudulent as well as legitimate claims. To that point, we continue, in all circumstances, to assume a claim is legitimate unless otherwise proven. Our intent with this letter is to make our GEGA clients aware of the situation and the actions we are taking to prevent any payment of fraudulent claims. We maintain a Fraud hotline at (877) 583-7541; please call to report any suspicious activities. We would encourage you to tell your employees about this scheme and to contact us if any of them are approached to participate. If you have any questions regarding this letter or the "rent-a-patient" situation, please contact your Signature Service Team. Thank you, Special Investigative Unit

Rent-a-Patient Fraud Scheme

Called "Rent-a-Patient" by the FBI, the activity involves providers performing unnecessary diagnostic tests and surgical procedures on patients that have health coverage and then billing the insurance companies - and other types of medical plans - for the fees related to those procedures. In many cases, it appears that the patients receive a payment from the providers to participate in the program. The scheme has impacted many carriers and other payers and it appears that millions of dollars in unnecessary claims may have been paid to providers participating in the scam.
Recently the FBI, the National Health Care Anti-Fraud Association (NHCAA) and over 60 insurance carriers met in Santa Monica to discuss the situation. The leader of GEGA's Special Investigative Unit attended that meeting and obtained valuable information that will assist us in reacting to this situation. GEGA is actively working through the NHCAA and the FBI to identify suspect claims and take appropriate action. This is an industry wide problem, with virtually every large provider of health insurance being affected. Beneficiaries, the "patients", participating in the scheme have been identified in all but seven states and over 1000 facilities are suspected to be somehow involved. According to the FBI, Latino, Vietnamese and Korean communities - for whom English may be a second language - are being targeted most aggressively to act as "patients". The FBI attributes over $1.7 Billion in health care fraud to the "Rent-a-patient" scheme.
Using information provided to us by the FBI, we have put together a "profile" of a fraudulent claim as well as "flagged" facilities that are suspected to have submitted a "rent-a-patient" claim. In spite of this we are still maintaining our commitment to pay all claims in a timely manner and adhere to all ERISA and state regulations. This is a very sophisticated scam that often involves many people. One of the bigger challenges of this situation is that some providers and facilities may be submitting fraudulent as well as legitimate claims. To that point, we continue, in all circumstances, to assume a claim is legitimate unless otherwise proven.
Our intent with this letter is to make our GEGA clients aware of the situation and the actions we are taking to prevent any payment of fraudulent claims. We maintain a Fraud hotline at (877) 583-7541; please call to report any suspicious activities. We would encourage you to tell your employees about this scheme and to contact us if any of them are approached to participate. If you have any questions regarding this letter or the "rent-a-patient" situation, please contact your Signature Service Team.

Thank you,
Special Investigative Unit