NEW YORK – Four people billed a health insurance company for 20 brain operations that were never performed on them, sometimes for the same person on multiple occasions, authorities said.
One 36-year-old man from New York City claimed nine brain surgeries for himself, along with his wife and two sons, receiving reimbursements from New York-based Group Health Incorporated totaling $142,268, federal investigators said Friday.
GHI paid out more than $300,000 in reimbursements to all four defendants, based on the claims.
Besides the 36-year-old man, an indictment filed in federal court alleges that a 39-year-old man from Mount Vernon, a 42-year-old woman and a 37-year-old man, both from New York City, defrauded the insurance company.
Three were in custody and are likely to be arraigned next week. The 36-year-old man remained at large.
The indictment alleges that the Mount Vernon man, an employee at a medical billing company, altered claims to the insurance company by swapping the names of people who actually underwent brain surgery with two others charged in the scheme.
The fraudulent claims were then sent along with altered postoperative reports to the insurance carrier for reimbursement, the indictment alleges.
Ilene Margolin, a spokeswoman for GHI, told The New York Times that her company's own internal investigators first noticed the defendants' unusual claims before turning over its findings to the government.