At its root, health-care fraud has more to do with the lack of control of the state Medicaid program than anything that comes out of Washington, according to Len Nichols, director of George Mason University’s Center for Health Policy Research and Ethics and a proponent of Obamacare. Medicaid’s day-to-day operations are administered by the states and funded through a joint partnership between the federal and state governments.
“They’re pretty desperate to switch the narrative away from 20 million uncovered,” said Nichols, referring to the number of people estimated to lose insurance under the Republicans’ proposed Obamacare replacement.
Sessions’s Priorities
In a sign of shifting priorities under Sessions, many of the planned arrests target people who’ve made fraudulent claims against major private health insurers, including Anthem Inc., Cigna Corp. and companies that sell insurance under the Blue Cross Blue Shield brand, the person said. Sessions himself plans to announce the arrests in Washington as soon as Thursday.
Anthem, which sells insurance plans under the Blue Cross and Blue Shield brand in 14 states, said it’s "actively working with federal and state law enforcement in several states on these types of cases.” An Anthem spokeswoman declined to comment on any specific investigation, but noted that the company has a special unit that investigates cases involving opioid fraud, waste and abuse.
Cigna said in a statement that the crackdown is “a positive step forward in the country’s efforts to drive greater accountability.”
Aetna Inc. declined to comment, and UnitedHealth Group Inc. and Humana Inc. didn’t respond to requests for comment. Florida Blue, the state’s Blue Cross and Blue Shield insurer, said it works with authorities to fight fraud in substance abuse treatment.
Florida Case
In one case unsealed Monday, Eric Snyder, the owner of an addiction treatment center and recovery home in Delray Beach, Florida, and an associate, were accused of filing $58 million of allegedly fraudulent claims to Blue Cross Blue Shield, Cigna, UnitedHealth, Aetna and Humana from 2011 to 2015, according to a criminal complaint filed in federal court in West Palm Beach. The insurers reimbursed the men $18.6 million for the fraudulent claims, according to an affidavit by an agent of the Federal Bureau of Investigation that’s attached to the complaint.
Snyder is accused of bilking insurers for years for services that weren’t needed or weren’t provided to treat drug addicts he recruited as patients, according to the FBI affidavit. Snyder delivered treatment by unqualified and unlicensed providers and paid illegal commissions for patient recruiters and kickbacks to patients themselves, the complaint says. The claims were all filed for coverage required under the Affordable Care Act, the affidavit states.