Home > Health Insurance Company: Fraud, Denials and Other Issues > Health Insurance Companies Should Pay $4.3 Billion for Defrauding Medicare/Medicaid

Health Insurance Companies Should Pay $4.3 Billion for Defrauding Medicare/Medicaid

The total amount that health insurance companies should pay for defrauding Medicare and Medicaid is $4,319,180,879 billion. The insurers have settled with the government for only $1,502,300,000 billion (34% of total fraud amount). The government settled at an average rate of 45% of the total amount defrauded. Total amount that was pocketed by the insurers (unrecovered) is $2,816,880,879 billion.  This is all found via public records. The amount of money in some recent cases that has been unreported (sealed by Judge) is probably a high amount as well and probably would greatly inflate the total amount I was able to find.
Amerigroup
—————-
Actual amount of Fraud:      $524,700,000
Settlements:                           $225,000,000    (Source 1)
% Settled for                           42%
—————————————————————-
 Blue Cross Blue Shield
Actual Amount of Fraud        $522,180,879     (Source 2, 3, 4, 5, 23)
Settlements:                            $302,100,000        (Source 6,7, 8, 9, 10, 23, 26)
% Settled for                            57%
 ———————————————————————————–
CareMark
Actual Amount of Fraud:        $110,000,000 million
Settlements:                           $54,200,000 million     (Source 26, 27,28)
 % Settled for                         49%
 —————————————————————————–
Cigna
Actual Amount of Fraud       $74,500,000
Settlements:                           $58,000,000   (Source 19)
% Settled for                           77%
 ————————————————————————–
 Humana
Actual Amount of Fraud       $311,800,000
Settlements:                           $155,500,000    (Source 13, 14, 15, 16)
% Settled for                           50%
——————————————————————————–
 Medco
Actual Amount of Fraud:       $430,000,000 million
Settlements:                            $155,000,000 million  (Source 24, 25)
% Settled for                            36%
 —————————————————————————-
 UnitedHealthcare /Pacificare
Actual Amount of Fraud       $1,300,000,000 billion (Source 17)
Settlements:                                  $97,500,000 million (Source 18, 19)
% Settled for                          7%
 —————————————————————————-
WellCare
Actual Amount of Fraud:         $1,046,000,000 billion (Source 20)
Settlements:                              $455,000,000 million  (Source 21, 22)
% Settled for                              43%
—————————————————————————
————————————————————————————————————————–
Total Fraud                                                               $ 4,319,180,879
Settlements                                                               $1,502,300,000
Average % of total fraud amount Settled for:  45%
Insurers Pocketed:                                                  $2,816,880,879
———————————————————————————————————————–
Sources:

22. http://www.ama-assn.org/amednews/2010/07/12/bisa0712.htm

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