Home > Health Insurance Company: Fraud, Denials and Other Issues > Health Insurance Companies Fined $5 Billion for Medicare Fraud and Other Fraud Violations!

Health Insurance Companies Fined $5 Billion for Medicare Fraud and Other Fraud Violations!

Health Insurance companies have been getting caught red-handed deliberately defrauding Medicare and Medicaid and other medical organizations for more than a decade. This is all due to insurance execs trying to get as much profit for their shareholders as possible. As a direct result of their felonious behavior,  insurance companies have been fined $2.694 billion for Medicare/Medicaid fraud and $2.435 billion for non-Medicare/Medicaid fraud (overcharging, not paying physicians, slow payments). This comes to a total $5 billion that health insurers have been fined for. The Department of Health and Human Services as well as the Office of Inspector General have officially declared “war” on health insurer fraud and are taking action to make sure this ceases.

Below is a listing of how much an insurer has been fined.

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Aetna

Q1 2012 Revenue: $8.92 billion    (cnbc.com)

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—————————————————————————————-
History of Non-Medicare Fraud:
Fined $750,000         – February 2010    (Source 12)
Fined $256,500         – November 2009  (Source 11)
Fined $20 million       – February  2009   (Source 24)
Fined $5.1 million      – February 2009    (Source 79)
Fined $6.25 million   – August 2003         (Source 10)
Fined $50,000            – June 2002           (Source 49)
Fined $1.4 million      – September 2001 (Source 7)
Fined $1.15 million   – November 2001  (Source 9)
Fined $1.9 million      – December 2000 (Source 8)
Fined $4.5 million       – December 1995  (Source 6)
Fined $89 million        – December 1994  (Source 6)
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 Medicare Fraud Fines:
Non-Medicare Fines:      $129,546, 500
Total Fraud Fines:        $129,546,500
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AmeriGroup
History of Medicaid Fraud
Fined $225 million        – July 2008  (Source 79)
Fined $144 million        – July 2006   (Source 79)
Fined $190 million       – July 2006   (Source 79)
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Total Fraud Fines:     $559 million
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Blue Cross Blue Shield
BCBS Illinois 2011 Revenue:  $1.1 billion
BCBS TN       2011 Revenue:  $5.2 billion
————————————————————————-
History of Medicare Fraud:
Fined $25 million   – February 2011 (Source 21)
Fined $225,000     – August 2010 (Source 18)
Fined $131 million  – April 2007   (Source 3)
Fined $1.5 million   – August 2005 (Source 82)
Fined $40 million   –  June 2003  (Source 1)
Fined $9.3 million  – July 2002   (Source 83)
Fined $74 million   –  December 1999  (Source 1)
Fined $261 million  – July 1999      (Source 16)
————————————————————————–
History of Non-Medicare Fraud:
Fined $480,000      – May 2012              (Source 43)
Fined $3.7 million – May 2012               (Source 78)
Fined $1.5 million   – March 2012          (Source 20)
Fined $1.6 million   – February 2012    (Source 14)
Fined $325,000       – April 2011           (Source 23)
Fined $5 million      – November 2010 (Source 13)
Fined $20 million   – September 2010 (Source 77)
Fined $95,000    – January 2010     (Source 22)
Fined $1 million      –  February  2009  (Source 19)
Fined $542,000      – August 2008        (Source 15)
Fined $2.1 million  – August 2008        (Source 50)
Fined $2.8 million   – March 2008         (Source 31)
Fined $1.25 million  – September 2006   (Source 85)
Fined $128 million  – May 2006            (Source 17)
Fined $23.7 million  – November 2005 (Source 85)
Fined $1.5 million      – August 2005     (Source 86)
Fined $150,000       – July 2005            (Source 47)
Fined $1.8 million   –  December 2003 (Source 48)
Fined $135,000      – June 2002            (Source 49)
 ———————————————————————————————
 Medicare Fraud Fines:                   $542,025,000
Non-Medicare Fraud Fines:          $194,327,000
 Total Fraud Fines:                          $736,952,000
 ——————————————————————————————————————————————
CareMark  Advantage
 Q1 2012 Revenue:  $30.8 billion   (cnbc.com)
 ———————————————————————
 History of Medicare Fraud:
 Fined $5 million         – May 2012 (Source 68)
Fined $7.5 million      –  February 2003  (Source 1)
 ———————————————————————–
Total Fraud Fines:                $12.5 million
 ——————————————————————————————————————————————
Cigna
Q1 2012 Revenue:  $6.9 billion (cnbc.com)
—————————————————————————-
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 25)
Fined $9 million       – March 2000         (Source 63)
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History of Non-Medicare Fraud:
Fined $1.2 million  –     April 2011             (Source 62)
Fined $20 million    –    February 2009    (Source 24)
Fined $97 million    –    July 2007             (Source 26)
Fined $150,000      –    January 2006      (Source 61)
Fined $540 million  –    September 2003 (Source 27)
Fined $80,000         –    June 2002            (Source 49)
—————————————————————————–
Medicare Fraud Fines:            $33.5 million
Non-Medicare Fraud Fines:   $657, 200,000 million
 Total Fraud Fines:                    $690,700,000 million
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First Health Services Corporation
 ————————————————–
History of Medicaid Fraud:
 Fined $13 million  –  April 2004   (Source 1)
 —————————————————–
History of Non-Medicare Fraud
Fined $150 million   –  June 2011 (Source 69)
 —————————————————-
Total Fraud Fines:         $163 million
——————————————————————————————————————————————-

HighMark Inc
————————————————–
History of Medicare Fraud:
Fined $1.5 million   – April 2004  (Source 1)
 ————————————————-
History of Non-Medicare Fraud
Fined $10 million   – October 2007 (Source 70)
 —————————————————–
Total Fraud Fines:       $11.5 million
 ——————————————————————————————————————————————
 Humana
Q1 2012 Revenue: $10.2 billion
———————————————-
Breaking News:
 Dept of Justice probing Humana for Fraud –   May 2012  (http://www.fiercehealthpayer.com/story/feds-probe-humana-claims-doc-loans/2012-05-04)
 Physician Exposes Humana Scam:   http://www.wejonesmd.com/Pages/Ins/humana.html
 ———————————————————————————————————
 History of Medicare Fraud:
Fined $3.4 million    –  August 2011  (Source 29)
Fined $133 million  – October 2005 (Source 4)
Fined $8 million       – June   2001 (Source 1)
Fined $14.5 million  –  June 2000 (Source 1)
Fined $8 million        – November 1999 (Source 28)
 ————————————————————–
 History of Non-Medicare Fraud:
Fined $45,000,000  – May 2012 (Source 84)
Fined $314,000     – June 2011  (Source 60)
Fined $299,000     –  June 2011 (Source 30)
Fined $100,000     –  January 2011 (Source 32)
Fined $55,800       – October 2010  (Source 60)
Fined $2.8 million  – March 2008 (Source 31)
Fined $500,000      – January 2008 ( Source 60)
Fined $500,000     – August 2007   (Source 60)
Fined $4,190,000 million – July 2005 (Source 60)
Fined $1,013,259 million – July 2005 (Source 60)
Fined $3.5 million   – May 2005    (Source 60)
Fined $10.2 million – November 2003 (Source 60)
Fined $106 million – October 2003 (Source 60)
Fined $78.5 million – January 2000 (Source 33)
Fined $10 million    – July 1999     (Source 33)
 ——————————————————————–
Medicare Fraud Fines:               $166,900,000 million
Non-Medicare Fraud Fines:      $264,740,859 million
Total  Fraud Fines:                      $431,640,859 million
 ———————————————————————
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Lovelace Health Plan
—————————
History of Medicare Fraud:
Fined $24.5 million  – December 2002 (Source 1)
 ——————————————————-
Total Fraud Fines:                    $24.5 million
 ——————————————————————————————————————————————
Medco Health Solutions
 ———————————
History of Medicare Fraud:
Fined $29 million  –  April 2004  (Source 1)
Fined $115 million – October 2006  (Source 1, Source 2)
—————————————————————
History of Non-Medicare Fraud
Fined $2.75 million  – March 2012 (Source 71)
Fined $29.3 million  – April 2004 (Source 72)
——————————————————–
Medicare Fraud Fines:            $144 million
Non-Medicare Fraud Fines:   $32,050,000
 Total Fraud Fines:                    $176,050,000 million
 ——————————————————————————————————————————————
 Rocky Mountain Health Plans
 ———————————–
Fined $1.5 million    –  August 1999 (Source 1)
—————————————————
Total Fraud Fines:     –  $1.5 million
 ——————————————————————————————————————————————
Tenet Choices Inc
———————-
History of Medicare Fraud:
Fined $8.25 million –  March 2004  (Source 1)
Fined $54 million    –  August 2003 (Source 1)
Fined $4 million    –  February 2003 (Source 1)
Fined $115 million  –  January 2003 (Source 1)
—————————————————–
Total Fines:               $177,650,000 million
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 UnitedHealthcare
Q1 2012 Revenue: $27.23 billion (cnbc.com)
 —————————————————-
History of Medicare Fraud:
Fined $3.5 million –  December 2004 (Source 34)
Fined $4 million   –   September 2002  (Source 1)
Fined $2.9 million –  November 2000   (Source 36)
———————————————————
History of Non-Medicare Fraud:
Fined $1.3 million  – May 2012           (Source 42)
Fined $20 million    – May 2012          (Source 39)
Fined $350 million  – October 2010  (Source 35)
Fined $457,000       – October 2010   (Source 38)
Fined $750,000      – November 2009 (Source 54)
Fined $500,000       – August 2009     (Source 40)
Fined $50 million    – January 2009   (Source 37)
Fined $250,000       – July 2008          (Source 41)
June $50,000          – June 2008         (Source 74)
Fined $2.8 million   – March 2008      (Source 44)
Fined $3.5 million   – January 2008  (Source
Fined $4.4 million   – December 2007  (Source 51)
Fined $12 million    – September 2007 (Source 45)
Fined $650,000      – May 2007              (Source 55)
Fined $59,500         – February 2007 (Source 43)
Fined $364,750       – March 2006      (Source 46)
Fined $350,000      – March 2006       (Source 52)
Fined $5,000          – January 2005    (Source 53)
Fined $2.8 million – January 2005    (Source 54)
Fined $150,000     –  May 2002         (Source 56)
Fined $87.3 million   –  April 2002 (Source 1)
Fined $35,900       – November 2000 (Source 59)
Fined $175,000     – April 2000         (Source 57)
Fined $127,400     – March 2000      (Source 58)
 ————————————————————
Medicare Fraud Fines:            $10,400,000
Non-Medicare Fraud Fines:   $538,024,550 million
 Total Fraud Fines:                    $548,424,550
 ——————————————————————————————————————————————
 WellCare
 —————————-
History of Medicare Fraud:
Fined $138 million            March 2012   (Source 75)
Fined $80 million             May 2009       ( Source 80)
——————————————————–
History of Non-Medicare Fraud
Fined $120,000   –  August 2009  (Source 76)
 ——————————————-
Total Fraud Fines:    $218,120,000
——————————————————————————————————————————————-
 WellPoint
Q1 2012 Revenue: $15.42 billion  (cnbc.com)
 —————————————————-
History of Medicare Fraud:
Fined $6 million       –  October 2005 (Source 81)
Fined $198 million  –  July 2005  (Source 5)
————————————————–
History of Non-Medicare Fraud:
Fined $100,000    – August 2008 (Source 64)
Fined $1 million   – March 2007    (Source 66)
Fined $80 million    – May 2005    (Source 67)
Fined $448 million  – July 2005      (Source 65)
 ——————————————————
Medicare Fraud Fines:             $204,000,000 million
Non-Medicare Fraud Fines:    $529,100,000 million
 Total Fraud Fines:                    $733,100,000
 ——————————————————————————————————————————————
 Total Medicare Fraud Fines:                    $2,694,475,000 billion
Total Non-Medicare Fraud Fines:           $2,506,958,859 billion
Grand Total Fraud Fines:                           $5,219,493,859 billion
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Sources:
10. http://articles.latimes.com/2003/aug/20/business/fi-rup20.4

25. http://articles.latimes.com/2002/dec/05/business/fi-cigna5

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