Gym Owner Scams Silver Sneakers

The theft of money by swindling private insurance companies as well as U.S. government programs such as Medicare and Medicaid is as prevalent and crazy as ever.

Want an example of the crazy?

The owner of a gym in New York State was recently convicted of health care fraud. The guy was filing bogus claims with insurance companies for reimbursement for programs offered at the athletic club.

Many of the fake claims involved the Silver Sneakers program, a benefit offered by private insurance companies that is especially popular with Medicare recipients who participate in Medicare Advantage plans.

Claims filed

Members of some Silver Sneakers programs are allowed to attend various programs offered by a gym, which then files an insurance claim for reimbursement.

The guy in New York was seeking reimbursement for people who he said attended such programs in his gym. The problem was the people he named were out of town at the time they supposedly took the class.

Other claims were filed for people who recently had surgery and were physically unable to do what the gym owner said they did. And get this: Claims were filed for people who were actually dead at the time they were supposedly doing yoga in the gym.

Fortunately this particular case of craziness was stopped. The gym owner got three years of probation, community service and a fine in excess of $50,000.

Hope for the future

What about the swindlers who have not yet been caught? There is hope there too.

In some parts of the country investigators are taking a high-tech approach to the problem.

These fraud hunters are analyzing health care reimbursement data submitted by providers. The providers are trusted to do the right thing. In many cases they do not and it results in great expense to the U.S. taxpayer.

Through some serious statistical analysis, the investigators may be able to spot fraudulent billing patterns along with wasteful and abusive practices.

Officials hope to bring to justice some sophisticated schemers who have escaped detection in the past.

Let’s hope they are successful.

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