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Selling Patients
Brokering schemes: 'Tampa Bay's dirty little medical secret.'
In some cases, medical facilities solicit accident victims for X-rays or other medical treatment, sometimes offering cash. In other instances, diagnostic imaging companies funnel money to medical clinics in exchange for referring patients for lucrative treatments that may or may not be needed. Usually, the patient has no idea what's happening, and unsuspecting auto insurers often are billed for services never rendered.
CRACKDOWN: Florida CFO Tom Gallagher says a re-evaluation of the state's PIP law may be in order.Cracking down on these schemes isn't always easy. "The way the schemes are woven, they are very hard to detect," Warder says.
Warder got a break during a recent investigation. A healthcare insider, a confidential informant, blew the whistle on a ring of clinics that had been preying on insured accident victims. The subsequent two-year investigation resulted in two batches of arrests involving 20 people, including a chiropractor and more than a half-dozen other medical facility owners.
Some clinic owners were collecting as much as $2,000 per patient in "referral fees" from diagnostic facilities, according to Warder. Others, like Pedro Luis Cabo, owner of Pro Medical & Rehab Center Clinic in Tampa, charged hundreds of dollars per referral. He was caught on tape taking $600 in exchange for "selling" two patients to an MRI diagnostic facility.
Patient brokering is "Tampa Bay's dirty little medical secret," Warder says, noting the crime seems to occur more often in the southwest region than elsewhere in the state. In south Florida, by contrast, staged auto accidents are more common.
Whatever the fraud, all Florida consumers pay the price. State officials estimate that insurance fraud -- including patient brokering schemes -- costs Florida families at least $250 annually in increased premiums.
Florida Chief Financial Officer Tom Gallagher says the situation may call for a re-evaluation of the state's PIP law, which requires drivers to carry a minimum of $10,000 in PIP coverage. "One of the things that's on the table is whether we continue having a 'no fault' law that has PIP coverage as a requirement," Gallagher says. He cautions, however, that he's not quite there yet. "We have to go slow on making that decision."
