It’s Not Brain Surgery

Sharp-eyed auditors for a health insurance provider noticed something that had them scratching their noggins.

According to reimbursement records, Stanley Cannella, his wife and their two sons had undergone nine brain surgeries in three years at a cost in excess of $142,000, with Cannella receiving reimbursement three separate times for the same procedure. As the auditors dug deeper, it was discovered that two more individuals and their families had received multiple reimbursements for the same procedure, none of which were actually performed. The payout for 20 different operations totaled more than $300,000.

The scam was traced to a billing technician, who police suspect had changed the names of legitimate patients to those of the three other defendants on insurance claim forms and post-operative reports so they could collect the reimbursements. The alleged perpetrators were indicted on multiple counts of mail and health care fraud.

— Joseph T. Wells, CPA, CFE, founder and chairman
of the Association of Certified Fraud Examiners