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True Crime of Insurance Fraud Video Number 73



Why some people think that insurance fraud is not a crime

See the full video at https://rumble.com/v14h8gs-true-crime-of-insurance-fraud-video-number-73.html and at https://youtu.be/QorXQ5w07qk

Dr. Scrooge was eighty-five years old. He lived with his daughter and son-in-law in a converted home outside of Portland, Oregon.

The doctor’s daughter had insisted that he move into her house, even though he owned his own, after his most recent heart attack. She was afraid that her father, now a widower, would give in to his passion for chocolate fudge ice cream.

Just two months before he moved to his daughter’s house, Dr. Scrooge consume a whole liter of chocolate fudge ice cream in a single sitting. Shortly thereafter, like all healthy people under the same circumstances, Dr. Scrooge felt severe chest pain.

There was no doubt that Dr. Scrooge had a heart condition. However, it was a condition that could be controlled with medication.

After moving in with his daughter, Dr. wrote Scrooge signed a contract with a healthcare organization that promised him no premium and better services than Medicare. Dr. Scrooge was always looking for a bargain and was happy with the plan even though it did not pay 100% of all his pharmacy fees. He had many drug samples in his house that were given to him by drug dealers. He did not expect to ever have to buy a drug. He happily filled out his own prescriptions for the medicine that his cardiologist prescribed to keep him healthy.

Dr. Scrooge’s son-in-law was a detective in the Bunco-Forgery Division of the Portland Police Department. The Portland police provided their police officers with an excellent health plan for the preferred supplier. They could use whatever doctor they wanted and only had to pay $ 5 for each prescription drug they bought, regardless of the actual cost of the drug. Dr. Scrooge’s HMO demanded a payment of up to $ 25 per prescription, depending on the cost of the drug.

Because he lived with them, Dr. Scrooge (although he did not actively practice) still had his medical license. At the request of his daughter, he would prescribe antibiotics and other benign drugs that were requested for the family’s help. Sometimes he even went to the pharmacy and picked up the drugs for the family as long as his daughter gave him a $ 5 note to the pharmacy.

Dr. Scrooge’s cardiologist was well read. He prescribed only the latest and most effective heart medications. The drugs he prescribed, as they were new and no generic variants were yet on the market, were extremely expensive. To Dr. Scrooge’s shock was also so new that he had none in his range of drug samples. The drug dealers knew he was retired and refused to give him any further samples.

Five months after Dr. Scrooge started his plan to save on prescription drugs, the detective was called into his captain’s office.

“When was your last physical?”

“About a year ago, Captain. Why do you ask?”

“I’m worried about your health, Wilson.”

“No reason, Captain, my health is perfect. The doctor gave me a clean bill and said I had cholesterol levels equal to a person ten years younger than me.”

“He did, he did. Wilson, are you using a doctor named Scrooge?”

“Well, I do not really use him as my doctor. He lives in my house. He is my father-in-law.”

“Wilson, I have a report here from our health insurance administrator stating that Dr. Scrooge has prescribed prescriptions for blood thinners, blood pressure mediators, diuretics and nitroglycerin, in your name. These drugs are only prescribed for people with a serious heart problem. Take those drugs. ? ”

“Dad, did you prescribe your heart medicine in my name?”

“Yes.”

“Why?”

“Because they only cost $ 5 on your insurance plan, and they cost $ 25 on min.”

“Do you not remember what I work on? Do you have no idea what you have done? You have committed fraud in my name!”

“But no one was hurt, the insurance company pays these bills all the time.”

Wilson, the next day, was forced to talk to his captain and inform him that his father-in-law had tried to save some money on his own insurance by making his prescriptions in Wilson’s name. He convinced the captain that even if the old man had technically committed a crime, it would serve no purpose to put him in prison at his advanced age. It can even make the old man happy because he would get the medicine for free in prison.

Wilson’s record was set, his next promotion delayed by twelve months. His father-in-law refused to fill his own prescriptions and pay the extra $ 20. Because he did not have the medication to take, he had a serious heart attack and was in hospital for three weeks.

Dr. Scrooge still believes no one is harmed by insurance fraud.


(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, now limits his internship to the position of insurance consultant specializing in insurance coverage, insurance claims handling, insurance bad faith and insurance fraud almost equally for insurers and policyholders. He practiced law in California for more than 44 years as a lawyer for insurance coverage and claims management and more than 54 years in the insurance industry. He is available at http://www.zalma.com and zalma@zalma.com.

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