Nobody’s Been Hurt

Why Some People Believe Insurance Fraud is no Criminal

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

There was no question that Dr. Scrooge had a heart condition. It was, however, a condition that could be controlled by medication.

After moving in with his daughter, Dr. Scrooge signed an agreement with a health maintenance organization who promised him no premium and better services than Medicare. 

Dr. Scrooge’s son-in-law was a detective with the Bunco-Forgery Division of the Portland Police Department. The Portland police provided its officers with an excellent preferred provider health plan. They could use any doctor they desired and were only required to pay $5 for every prescription drug they purchased regardless of the true cost of the drug. Dr. Scrooge’s HMO required a payment of up to $25 per prescription, depending on the cost of the drug.

Since he lived with them, Dr. Scrooge, started to write his heart medications prescriptions in the name of his son-in-law.

Five months after Dr. Scrooge started his plan of saving on prescription drugs, the detective was called into his captain’s office about his health and he then interrogated Dr. Scrooge.

“Dad, have you been writing prescriptions for your heart medicine in my name?”

“Yes.”

“Why?”

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

“Don’t you remember what I do for a living? Have you 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 speak to his captain and inform him that his father-in-law had attempted to save some money on his own insurance by making his prescriptions out in Wilson’s name. He convinced the Captain that, although technically the old man had committed a crime, it would serve no purpose to put him in prison at his advanced age. It might even please the old man because, in prison, he would get the medicine for free.

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 real heart attack and was hospitalized for three weeks.

Dr. Scrooge still believes that no one is hurt by insurance fraud.

(c) 2022 Barry Zalma & ClaimSchool, Inc.

Barry Zalma, Esq., CFE, is available at http://www.zalma.com and [email protected].

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