LAW OFFICE OF PETER M. FEAMAN: Healthcare Billing Fraud in Florida Damages Business Relationships

By Press release submission | Sep 9, 2018

Law Office of Peter M. Feaman issued the following announcement on Sept. 4.

Business fraud can take on a variety of different forms, but often occurs when business’s are scammed by customers and counterfeiters. Unfortunately, almost half of small businesses are victimized by fraud, and at an average cost of $114,000 per occurrence, it can quickly bankrupt a small company. In one interstate case, alleged billing fraud has cost an insurance company millions of dollars.

$13.5 Million at Stake

Anthem Blue Cross, one of the nation’s largest insurance companies, contracts with a wide range of care providers to provide service options to subscribers. Reimbursement rates for services vary, based on both the type of provider and its location. In February of 2018, Anthem Blue Cross alleged that Sonoma West Medical Center in California participated in a scheme to collect money for toxicology testing services that it did not provide.

Sonoma West Medical Center, a chronically money-strapped hospital, reached an agreement to process samples for Florida-based company Durall Capital Holdings, which owns Reliance Laboratory Testing. Anthem alleged that Reliance Laboratory tested samples and sent portions of each sample to Sonoma West for the hospital to perform additional screenings. Anthem accused Sonoma West of billing Anthem for all or part of the tests, even when the hospital did not actually have any ties to the patients whose urine samples were being tested.

Payout amounts vary quite a bit between hospitals and laboratories like Reliance, with hospitals receiving up to 10 times more money than labs for the same procedures. Anthem’s lawyer noted that the disparity in reimbursement rates was the only benefit that Sonoma West provided its alleged partner in the scheme.

These significant payout differences added up quickly. In total, Anthem claimed that it paid out more than $13.5 million in fraudulent payments to the hospital.

What’s Next for Reliance Laboratory Testing and Sonoma West Medical Center?

The stakes are high when there are millions of dollars changing hands. Sonoma West Medical Center defends its innocence, claiming that it is standard for toxicology testing to take place at outside laboratories. The court battle continues, and Sonoma West Medical Center is still struggling. It runs at a deficit every month, a common plight for rural hospitals. Hospital officials are considering closing the facility, which would leave western Sonoma County without emergency room services.

If Anthem’s claims are true, the company could be out millions. Even if the court orders Sonoma West to repay Anthem, it’s unlikely that a struggling hospital at risk of closure could repay such a large sum of money. This could leave Anthem, the alleged victim, footing the bill and absorbing the costs.

Preventing Business Fraud

Careful analysis and data tracking are key aspects of business fraud prevention. By following payment trends, businesses can catch potential fraud early and minimize the financial fallout.

With everything else that needs a business owner’s attention, it can be challenging to observe trends that point to fraud. A business attorney with extensive experience in fraud can look for red flags in a company’s operations, so that business owners can focus on what they do best. Business attorneys can also handle the litigation of potential fraud cases, putting owners in a much better position to recoup their losses.

Original source can be found here.

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