It’s Not Brain Surgery

BY JOSEPH T. WELLS

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

RESOURCES

Keeping you informed and prepared amid the coronavirus outbreak

We’re gathering the latest news stories along with relevant columns, tips, podcasts, and videos on this page, along with curated items from our archives to help with uncertainty and disruption.

VIDEO

Excel walk-through: Sparklines

Want to liven up your spreadsheets with some color and graphical elements? Kelly L. Williams, CPA, Ph.D., shows how to use Excel sparklines, which illustrate data trends and patterns via small charts that fit in a single Excel cell.