Scammers getting rich by overbilling Medicare

Couple ordered to pay $5 million in restitution


RALEIGH, N.C. – One of the most common types of health care fraud involves doctors, clinics or companies billing for more expensive procedures than patients actually receive.

It's driving up the cost of health care, and in the long run, everyone is paying the bill.

U.S. Postal Inspector Michael Carroll said that billing complicated, complex procedures to Medicare generates a higher payment to the provider.

It's becoming a growing problem, as more and more people live longer and are on Medicare.

"What that ultimately does is it raises medical costs for everyone," Carroll said. "In essence, every single person in this country is a victim of this crime."

One husband and wife duo recently pleaded guilty to charges related to just such a scam. Donald and Shirley Blaine, who formed a company called Respa-Test, were sentenced and ordered to pay $5 million in restitution.

"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," Carroll said. "(But) our investigation showed that the procedures that were actually completed in the office were very simple procedures, low-cost procedures that might be billed to Medicare for $3 or $5."

Postal inspectors said the Blaines 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.

Postal inspectors said it's important to 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 (a) much higher price than what you think it should have been billed at, then you need to call the insurance company," Carroll said.