Check your information carefully: Medical fraud on the rise in Atlanta

It is always a good idea to check your Explanation of Benefits as one man found when he discovered he had been charged $8,000 for a service he had not received. Had this gentleman not been vigilant he would have been caught out. If he had been to a doctor recently, he may have overlooked the fee thinking it was for something else. If his family had to take care of his health and wellbeing, they may too have overlooked the charge to his name.

He turned the matter over to the fraud department of Blue Cross and Blue Shield of Georgia, which operated his Medicare Advantage health plan, which led to a staggering $1 million dollar fraud recovery.

Atlanta a new hotbed for medical fraud

The Atlanta area is a hotbed of health care fraud, says Lavelle, director of investigations for WellPoint’s health plans in the Central and Southeast regions.

Many perpetrators have moved to Georgia from the south Florida area, where health care fraud has been rampant and has drawn a heavy crackdown from law enforcement.

“Atlanta has so many hospitals, so many doctors, there’s an easy fit [for fraudulent providers] into the market,’’ says Lavelle.

“We have to stay as smart as the crooks,’’ she says. “We have to stay ahead of the curve. The crooks are getting smarter and better.’’