20 False Brain Surgery Claims Cost Insurance Company More Than $300,000

According to Reuters, four individuals illegally billed a health insurance company for twenty brain operations that were never performed. In fact, sometimes the bills were for a brain operation on the same person, according to authorities.

One man from New York City alone, 36, claimed to have had nine brain surgeries performed on him, along with his two sons and wife. The total amount of money reimbursed from Group Health Incorporated was $142,268, said federal investigators on Friday.

Group Health Incorporated reimbursed more than $300,000 to all four defendants, according to the claims.

In addition to the 36-year-old man, a 39-year-old man from Mount Vernon, a 42-year-old woman, and a 37-year-old man, both from New York City, allegedly defrauded the insurance company.

All three of the other individuals accused of defrauding Group Health Incorporated are being held in police custody and are most likely going to be arraigned within the following week. However, the 36-year-old man from New York City is still at large.

The man from Mount Vernon is an employee at a medical billing company. The indictment against him alleges that he changed the claims to the insurance company by switching the names of those who legitimately underwent a brain surgery procedure with the two other individuals who are being charged in this scam. The indictment alleges that the illegal and fraudulent claims were then forwarded4d to the insurance company for reimbursement.

A spokeswoman for Group Health Incorporated, Ilene Margolin, told The New York Times that the insurance company first noticed the defendants' abnormal claims before forwarding those claims to the government.

According to the Coalition Against Insurance Fraud, about one-fourth of Americans believe it is acceptable to defraud insurance companies. In addition, approximately one out of every ten Americans would not hesitate to commit insurance fraud if it were guaranteed he/she would "get away" with it. Moreover, it is estimated that about one in every ten people believe submitting claims for items that are neither lost nor damaged is acceptable. The same applies for personal injuries that have never occurred.

According to Resource4 Surgical Accidents, brain surgery is by far the most complicated surgery. The risks of undergoing brain surgery include damage and infection to nerves and/or blood vessels, stroke, or even death.