Learn How to Avoid Health Care ID Theft

New federal regulations aimed at detecting potential health identity theft are changing some procedures at Grand Valley businesses.

Patients checking in at local hospitals or physicians’ offices can now expect to show photo identification at every visit. That wasn’t always the case, local hospital officials said.

In November, a new regulation from the Federal Trade Commission required all financial institutions and creditors to develop an identity theft prevention program. Health care providers fit into the category of creditor because they can extend credit to patients and report people to collection agencies.

Read more at the Grand Junction Sentinel.

Druggist Sentenced to 180 Days in Jail for Insurance Fraud

A pharmacist was sentenced yesterday to 180 days in jail for submitting fraudulent prescriptions to an insurance company to collect more than $80,000.

William Schobert, 50, of Wellington Drive in Lumberton pleaded guilty in June to a single count of health-care claims fraud.

Woman Charged in Insurance Fraud

A local health care worker has been indicted on 20 federal wire fraud charges for allegedly billing for more than $242,000 in life insurance screening exams that she never conducted.

Sally Ann Hodge, 49, was supposed to be providing health exams for people applying for life insurance, and submitting her bills to a Colorado company, her indictment says. In return, Hodge received between $30 and $100.

Excellus, IBM Work Together to Fight Fraud

Excellus BlueCross BlueShield and IBM Corp. are working together to fight health care insurance fraud.

IBM’s Risk Identification Analysis Service will be used by Excellus to review pharmacy-related claims to uncover complex schemes, the companies said. Such schemes include collusion, inappropriate billing practices, prescription forging, prescription pad theft and members who engage in “doctor shopping.”

“Someone who knowingly commits insurance fraud is no different than any other person who steals,” said Flora Allen, corporate director of Excellus’ special investigations unit. “Fraud affects everyone’s bottom line, so we aggressively and proactively pursue recoveries and convictions because we are protecting our members’ premiums.”