Pain Physician Scams: When Physicians
Cross the Line of Ethical Patient Treatment
Cross the Line of Ethical Patient Treatment
Pain physician scams may take many forms including deception, bait and switch, failure
to follow Medicare law, Medicaid fraud, running a pill mill, insurance fraud, not
disclosing to patients that treatments are experimental or unproven, intentional
miscoding procedures, using quack therapies that have been disproven, etc. Pain
patients are particularly susceptible to these scams due to the limited options for
treatment available to them and due to excessive trust in judgement of the referring
physician. Here are some of the scams to watch out for and what to do if you
encounter them.
PHYSICIAN SCAMS AND FRAUD
FRAUD BY DECEPTION: Some physicians own surgery centers that are not in any
way identified on their literature they send to patients or may not be identified even on
the outside of the building. The patient is seen by a physician that accepts their
insurance in-network, then tells the patient they will be having a procedure in a
surgery center that is in the same building, but the surgery center is intentionally not in-
network so the physician-owner can charge astronomical rates well above that
permitted by insurance contracts. The surgery center may not even be labeled
anywhere visibly on the outside of the building (intention to conceal its existence) and
will have a different name than the physician's practice. Sometimes the physician will
not specify they own the surgery center or will bury this information in stacks of paper
given to the patient. They do not tell the patient there are other options available that
are far less expensive especially when the physician is on-staff at other surgery
centers or hospitals where the rates would be much lower since the legitimate surgery
centers are in-network. The physician could actually do most pain procedures in their
own office without using a surgery center, and this option costs the patient only a small
fraction of the amount being charged by the physician owned out-of-network surgery.
When the patient arrives for the procedure at the physician's surgery center they are
told they must pay $500-2000 up front and the physician will bill the insurer for the
balance. The overall cost of the procedure may be $5,000 per procedure in these out-
of-network surgery centers compared to 1/5 that in a hospital or 1/10 of that in an
office. Cost to the patient may be 10-20 times higher in a physician-owned out of
network surgery center than next door in his office.
So why doesn't the physician get his surgery center in network or do the procedures at
a location that would cost the patient much less? Greed. Just simple greed. The
physician makes as much doing one 15 minute procedure in a surgery center as the
family practice doctor makes in 2 weeks of work. Patients may be charged as much for
one procedure as they make in 3 months of work. The procedure may not work at all
or give only temporary partial relief. The physician may lie to the patient about the
procedure telling them it will “fix” the problem or should last a year or more. One
tipoff about physicians that may be scamming patients is their statements about cost....
if they state verbally in print that you should not be concerned about cost since the
price of your health is invaluable, run the other direction!!!
What violations is the physician guilty of in this type of scam? 1. Theft by deception
(state law) 2. Physician overcharging (state law) 3. Failure to inform the patient of
other options being available and failure to refer a patient as required by law (state
law) 4. Deception due to the surgery center not being labeled (medicare fraud). 5.
Malpractice for stating an injection would “fix” a problem permanently. Your recourse:
print off the complaint form at the end of this section and send it to the attorney
general if you believe your rights have been violated and that you are being
overcharged. Also, contact your insurer (their telephone number is on the back of your
insurance card) and tell their operator you would like to report insurance fraud.
BAIT AND SWITCH: The physician may be “in-network” (fixes the rates the
physician may charge) but will have other physicians, nurse practitioners, or physician’s
assistants who are intentionally out of network seeing the patients, either as new or
referred patients. The physician who is listed in the insurance list of covered
physicians is not the one seeing the patient so he can charge out of network rates that
may be as high as $650 for the initial patient consultation and $165-200 for a patient
follow-up visit. Since these are out of network costs, the physician balance bills the
patient for the remainder of the charges not covered by insurance. The pain providers
that are known by the physician to not be in network and remain out of network for
the purpose of overcharging patients. Legitimate pain clinics will have all providers
(MD, NP, PA, etc) in the same advertised network or at least having applied for in-
network status at the time of a patient visit. It is deception by advertising in insurance
company literature or in print or on websites that the practice is in-network when in
fact patients are being shunted to providers not in-network for the purpose of
overcharging. Report this to the attorney general and your insurance carrier. You
may also have grounds to sue the physician in civil court for overcharging due to
deceptive practices. Reporting physicians for this type of scam is not time limited and
you may be able to recover some of your hard cash long after the infraction.
MEDICAID FRAUD: Medicaid is not an insurance carrier, it is a law to protect the
poor. Therefore physicians that try to charge Medicaid patients out of pocket fees not
allowed by the Medicaid program, even if the physician does not accept Medicaid or is
not involved in the Medicaid program, may be a violation of Medicaid law. Contact your
Medicaid office listed at the end of this document. Charging for services not provided is
clearly a violation of law.
MEDICARE FRAUD: Over coding (using a CPT code ending in level 4 or 5 for a
minimal office visit in which there was no more than 15 minutes of direct contact with
the physician may constitute fraud, especially if a complete history and physical exam
was not performed on each visit. For lesser codes ending in 3, a 15 minute visit is a
justified Medicare charge. It is also fraud to claim patients received significant relief
during a spinal cord stimulator trial in order to defraud Medicare into paying for a full
spinal cord implanted system. It is also fraud to state the patient had more than 50%
relief after a temporary diagnostic block in order to get Medicare to pay for a more
expensive therapeutic radiofrequency procedure. Report Medicare fraud to the
telephone number listed at the end of this document. Physicians may intentionally
miscode things that are specifically not covered by Medicare as alternative therapies
that are. For instance, Accuspina, DRX, Vax-D are spine traction devices specifically
stated by Medicare they are not covered, but the physician may submit a bill to
Medicare anyway calling this “physical therapy”. This is simple fraud.
PILL MILLS: Physicians or NPs that give out massive number of pills to patients
without seeing them in follow-up, and have the patient come to the front office
window to pick up scripts are not doing due diligence in their monitoring of patient
activity. Fully 25-35% of people attending pain clinics are abusing opioid narcotics or
are selling them, therefore a formal face to face assessment is necessary rather than
handing over narcotics to patients without patient assessment. The number of
patients seen is also an indication: physicians or NPs that see more than 35 patients a
day each are not giving sufficient time to patient care. Some physicians will see 90-100
patients per day for narcotics. This activity can be reported to your local police
department and to the attorney general via this form.
Why should I report this activity? Because some of these "patients" are really drug
addicts, and would as soon follow you to the pharmacy and rob you of your
medications when you leave (or follow you home). Also, the doctors in the community
recognize a pill mill and once they know you are being treated in one of these, you will
receive different treatment from other doctors and pharmacists.
What creates pill mills? Doctors that advertise directly for patients in flyers, brochures,
newspapers, websites, or TV/radio without requiring a referral from their family
physician or other physician are asking for trouble, and rapidly acquire an out of control
drug addict population.
REPORTING PHYSICIAN FRAUD
HOW TO REPORT OVERCHARGING TO AUTHORITIES:
Gather the information about the surgery center from the list below (address, name,
etc), print out the complaint form for the attorney general's office (click here) and
send to the attorney general’s office referencing Indiana State Code 844 IAC 5-2-9(a)
and (b). This is the reference for the Indiana state law preventing physicians from
charging excessive fees. Notify your insurer by calling the number on the back of your
insurance card or from the insurance fraud hotline list below, and ask the operator to
permit you to talk to the appropriate person about insurance fraud. If your insurance is
not listed, then contact member services. Most importantly, inform your referring
physician (frequently a family physician or internist) of the massive overcharge or
proposed excessive charges so they will not make the same mistake again. If the
referring physician continues to refer you to such facilities and physicians that
massively overcharge, tell the physician you do not wish to ever be referred to these
places since they are unaffordable, and ask him to note that on your chart.
HOW TO REPORT THEFT BY DECEPTION TO AUTHORITIES:
If the physician failed to tell you in writing that he owned part of the surgery center
or if he did not inform you that you could be referred to another health care facility this
is fraud . You would have had to sign a specific form in the physician’s office for this
purpose and he is required to keep this on file. If this was not done or he did not in
writing give you the option to be referred to another facility, you may report the
physician to the attorney general (click here for the form) referencing Indiana law IC
25-22.5-11-3
If the physician is defrauding you by over-utilization such as scheduling all at one
time a “series of 3 injections” without each time evaluating the success of each block or
repeating injections over and over that did not work even temporarily, or scheduling a
spinal cord stimulator implant or radiofrequency procedure without at least 50% pain
relief during the trial implant or injection, etc, then this constitutes both insurance fraud
and a violation of the medical practice act of Indiana. False advertising, including
exaggerated expected degree of relief of pain or length of time the injection or
procedure will last is also a violation of the same law and should be reported to the
attorney general’s office (click here for the form) and the insurer. (eg. If a physician
says an epidural injection will last up to a year or says the range is 1-24 weeks this is
not fraud, but if he says the injection should give relief for a year or more this is fraud.
If he says a radiofrequency neurotomy will last indefinitely or will “fix” the problem,
this is fraud). If a nurse practitioner, physicians assistant, or physician is billing you for
services not provided such as upcoding an office visit to a CPT code ending in “4 or 5”
for a 15 minute visit, this is probably fraud unless a complete physical exam is
performed on each visit of your heart, lungs, thyroid, abdomen, etc. If a nurse
practitioner or physician’s assistant are not in-network, but the physician is, and you
are denied the ability to see the physician or are shunted to the out of network PA or
NP, this may be both insurance fraud and theft by deception. For all the situations
above, a complaint may be filed with the attorney general’s office and the insurer.
Indiana Law IC 25-1-9-4 should be referenced in the complaint.
If the physician waives your responsible amount that insurance will not pay as an
inducement to have procedures or surgeries while having your insurance company for
the overcharges, this is insurance fraud and should be reported to the insurer and the
attorney general’s office as above and to the Indiana Department of insurance at:
IDOI
Attn: Consumer Services Division
311 W Washington Street, Suite 300
Indianapolis IN 46204-2787
Or Fax to:
317-234-2103
.
HOW TO REPORT AN ILLEGAL OPERATION: If the surgery center is not
clearly marked as a surgery center on the outside and inside of the building, or if the
physician is using a common waiting room or staff for both surgery and office patients
at the same time, this is an illegal operation. Call the acute care division of the Indiana
Department of Health. They regulate and license ambulatory surgery centers and you
may lodge a complaint with them by emailing complaints@isdh.in.gov AND THEN writing
Indiana State Department of Health
Division of Acute Care
2 North Meridian Street, 4A
Indianapolis, IN 46204
AND it is suggested to call one of the following numbers stating up front that you wish
to lodge a complaint against a surgery center (ASC).
(317) 233-7474 (Acute Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
AND
Contact the Office of the Inspector General, Federal Government via email at
HHSTips@oig.hhs.gov stating the facility sees medicare patients and may be
defrauding them through illegal operation.
REPORTING MEDICARE FRAUD
Before contacting the Medicare claims processing company, carefully review the facts as you
know them and as shown on the Medicare Summary Notice. Write down:
•The provider's name and any identifying number you may have.
•The item or service you are questioning.
•The date on which the item or service was supposedly furnished.
•The amount approved and paid by Medicare.
•The date of the Medicare Summary Notice.
•The name and Medicare number of the person who supposedly received the item or service.
•The reason you believe Medicare should not have paid.
•Any other information you may have showing that the claim for the item or service should
not have been paid by Medicare.
If you plan to write rather than call, clearly state at the beginning of your letter that you
are filing a fraud complaint. This will help to ensure that your complaint is forwarded to the
fraud unit.
By Phone: 1-800-HHS-TIPS (1-800-447-8477)
By Fax: 1-800-223-2164
(no more than 10 pages please)
By E-Mail: HHSTips@oig.hhs.gov
By Mail: Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
REPORTING MEDICAID FRAUD
■Billing for services not provided
■Billing for unnecessary treatment or testing
■Billing for medical services that are actually provided by unlicensed or excluded personnel
■Billing for lengthy counseling sessions when only short sessions are provided
■Making a patient pay more than a Medicaid-approved co-payment for services
To report such fraud you may click here to go to the Indiana Medicaid reporting
website or you may call the Medicaid Fraud Control Unit at 800.382.1039.
REPORTING INSURANCE FRAUD:
Anthem (Indiana): 1-877-283-1524 Fraud Hotline
Assurant Health : 1.800.800.3830 Ext. 8324
SIHO Member services: (800) 443-2980
Cigna:call 1.800.667.7145 or e-mail: specialinvestigations@cigna.com
Aetna: email aetnasiu@aetna.com
Humana, United Health Care, Sagamore contact the customer service number on your
insurance card
Surgery Centers in the Area:
Columbus Pain Institute LLC (assumed name) aka XRS LLC (legal name)
(located inside the Wellspring Pain Solutions building)
2400 NORTH PARK, SUITE 20 COLUMBUS, IN 47203
Status as of 7 1 2010: Not accredited by JCAHO, AAAASF, AAAHC, or HFAP or by any
accrediting agency. Not a member of the Chamber of Commerce
Owner: Registered agent with Secretary of State of Indiana:
ANDREW ROBERTSON, 12880 W SAWMILL RD,
COLUMBUS , IN 47201
Additional local medical staff privileges: Columbus Surgery Center
and Columbus Regional Hospital
Columbus Surgery Center
(located inside the Columbus Surgery Center/SIO/CRH PT Building)
940 North Marr Road, Suite B • Columbus, Indiana 47201
Accredited by AAAHC Member of the Chamber of Commerce
Owner: Genesis (approximately 13 physicians) and Columbus Regional Hospital,
each 50% owner. Additional local medical staff privileges: Columbus Regional Hospital
for most physicians, some have privileges at Schneck Medical Center, St Vincent’s North
Vernon, and St Francis
Pankratz Eye Institute
3135 Middle Rd, Columbus, IN 47203
Registered agent: TIMOTHY H WALL, 8465 KEYSTONE CROSSING BLVD STE 160,
INDIANAPOLIS , IN 46240
SOUTH CENTRAL SURGERY CENTER LLC
5002 E STATE ROAD 44
FRANKLIN, IN 46131
Administrator: NANCY PENN, RN,DON
License Number : 10-003073-1
FRANCISCAN SURGERY CENTER LLC
(located inside the 5255 Building)
5255 E STOP 11 ROAD, SUITE 100
INDIANAPOLIS, IN 46237
Administrator: STEPHEN WHEATLEY
INDIANA ORTHOPAEDIC SURGERY CENTER
(located inside the 5255 Building)
5255 E STOP 11 ROAD, SUITE 110
INDIANAPOLIS, IN 46237
Administrator: JANE KELLER
INDIANA SURGERY CENTER-SOUTH
(located inside Community South Hospital)
1550 E COUNTY LINE ROAD
INDIANAPOLIS, IN 46227
Administrator: MARK WALKE
Other ways to lodge complaints about overcharging or
fraud
1. Board of Medical Licensure E-mail: pla3@pla.IN.gov (in addition to attorney
general report)
2. Better Business Bureau online complaint form https://odr.bbb.
org/odrweb/public/complaintlink.aspx
3. National Insurance Crime Bureau (NICB). 800-835-6422. You are allowed to
keep your identity anonymous when reporting fraudulent information
4. Report to Insurance fraud online http://www.insurancefraud.com/node/5
5. Email “The Republic” newspaper KJohannesen@therepublic.com
6. Call 6- the TV Channel 6 Investigative Line: You can call the WRTV news desk at
(317) 269-1440, TheIndyChannel Web staff at (317) 269-1476, or send us mail at:
WRTV (or TheIndyChannel.com) 1330 North Meridian Street Indianapolis, IN 46202-
2364
to follow Medicare law, Medicaid fraud, running a pill mill, insurance fraud, not
disclosing to patients that treatments are experimental or unproven, intentional
miscoding procedures, using quack therapies that have been disproven, etc. Pain
patients are particularly susceptible to these scams due to the limited options for
treatment available to them and due to excessive trust in judgement of the referring
physician. Here are some of the scams to watch out for and what to do if you
encounter them.
PHYSICIAN SCAMS AND FRAUD
FRAUD BY DECEPTION: Some physicians own surgery centers that are not in any
way identified on their literature they send to patients or may not be identified even on
the outside of the building. The patient is seen by a physician that accepts their
insurance in-network, then tells the patient they will be having a procedure in a
surgery center that is in the same building, but the surgery center is intentionally not in-
network so the physician-owner can charge astronomical rates well above that
permitted by insurance contracts. The surgery center may not even be labeled
anywhere visibly on the outside of the building (intention to conceal its existence) and
will have a different name than the physician's practice. Sometimes the physician will
not specify they own the surgery center or will bury this information in stacks of paper
given to the patient. They do not tell the patient there are other options available that
are far less expensive especially when the physician is on-staff at other surgery
centers or hospitals where the rates would be much lower since the legitimate surgery
centers are in-network. The physician could actually do most pain procedures in their
own office without using a surgery center, and this option costs the patient only a small
fraction of the amount being charged by the physician owned out-of-network surgery.
When the patient arrives for the procedure at the physician's surgery center they are
told they must pay $500-2000 up front and the physician will bill the insurer for the
balance. The overall cost of the procedure may be $5,000 per procedure in these out-
of-network surgery centers compared to 1/5 that in a hospital or 1/10 of that in an
office. Cost to the patient may be 10-20 times higher in a physician-owned out of
network surgery center than next door in his office.
So why doesn't the physician get his surgery center in network or do the procedures at
a location that would cost the patient much less? Greed. Just simple greed. The
physician makes as much doing one 15 minute procedure in a surgery center as the
family practice doctor makes in 2 weeks of work. Patients may be charged as much for
one procedure as they make in 3 months of work. The procedure may not work at all
or give only temporary partial relief. The physician may lie to the patient about the
procedure telling them it will “fix” the problem or should last a year or more. One
tipoff about physicians that may be scamming patients is their statements about cost....
if they state verbally in print that you should not be concerned about cost since the
price of your health is invaluable, run the other direction!!!
What violations is the physician guilty of in this type of scam? 1. Theft by deception
(state law) 2. Physician overcharging (state law) 3. Failure to inform the patient of
other options being available and failure to refer a patient as required by law (state
law) 4. Deception due to the surgery center not being labeled (medicare fraud). 5.
Malpractice for stating an injection would “fix” a problem permanently. Your recourse:
print off the complaint form at the end of this section and send it to the attorney
general if you believe your rights have been violated and that you are being
overcharged. Also, contact your insurer (their telephone number is on the back of your
insurance card) and tell their operator you would like to report insurance fraud.
BAIT AND SWITCH: The physician may be “in-network” (fixes the rates the
physician may charge) but will have other physicians, nurse practitioners, or physician’s
assistants who are intentionally out of network seeing the patients, either as new or
referred patients. The physician who is listed in the insurance list of covered
physicians is not the one seeing the patient so he can charge out of network rates that
may be as high as $650 for the initial patient consultation and $165-200 for a patient
follow-up visit. Since these are out of network costs, the physician balance bills the
patient for the remainder of the charges not covered by insurance. The pain providers
that are known by the physician to not be in network and remain out of network for
the purpose of overcharging patients. Legitimate pain clinics will have all providers
(MD, NP, PA, etc) in the same advertised network or at least having applied for in-
network status at the time of a patient visit. It is deception by advertising in insurance
company literature or in print or on websites that the practice is in-network when in
fact patients are being shunted to providers not in-network for the purpose of
overcharging. Report this to the attorney general and your insurance carrier. You
may also have grounds to sue the physician in civil court for overcharging due to
deceptive practices. Reporting physicians for this type of scam is not time limited and
you may be able to recover some of your hard cash long after the infraction.
MEDICAID FRAUD: Medicaid is not an insurance carrier, it is a law to protect the
poor. Therefore physicians that try to charge Medicaid patients out of pocket fees not
allowed by the Medicaid program, even if the physician does not accept Medicaid or is
not involved in the Medicaid program, may be a violation of Medicaid law. Contact your
Medicaid office listed at the end of this document. Charging for services not provided is
clearly a violation of law.
MEDICARE FRAUD: Over coding (using a CPT code ending in level 4 or 5 for a
minimal office visit in which there was no more than 15 minutes of direct contact with
the physician may constitute fraud, especially if a complete history and physical exam
was not performed on each visit. For lesser codes ending in 3, a 15 minute visit is a
justified Medicare charge. It is also fraud to claim patients received significant relief
during a spinal cord stimulator trial in order to defraud Medicare into paying for a full
spinal cord implanted system. It is also fraud to state the patient had more than 50%
relief after a temporary diagnostic block in order to get Medicare to pay for a more
expensive therapeutic radiofrequency procedure. Report Medicare fraud to the
telephone number listed at the end of this document. Physicians may intentionally
miscode things that are specifically not covered by Medicare as alternative therapies
that are. For instance, Accuspina, DRX, Vax-D are spine traction devices specifically
stated by Medicare they are not covered, but the physician may submit a bill to
Medicare anyway calling this “physical therapy”. This is simple fraud.
PILL MILLS: Physicians or NPs that give out massive number of pills to patients
without seeing them in follow-up, and have the patient come to the front office
window to pick up scripts are not doing due diligence in their monitoring of patient
activity. Fully 25-35% of people attending pain clinics are abusing opioid narcotics or
are selling them, therefore a formal face to face assessment is necessary rather than
handing over narcotics to patients without patient assessment. The number of
patients seen is also an indication: physicians or NPs that see more than 35 patients a
day each are not giving sufficient time to patient care. Some physicians will see 90-100
patients per day for narcotics. This activity can be reported to your local police
department and to the attorney general via this form.
Why should I report this activity? Because some of these "patients" are really drug
addicts, and would as soon follow you to the pharmacy and rob you of your
medications when you leave (or follow you home). Also, the doctors in the community
recognize a pill mill and once they know you are being treated in one of these, you will
receive different treatment from other doctors and pharmacists.
What creates pill mills? Doctors that advertise directly for patients in flyers, brochures,
newspapers, websites, or TV/radio without requiring a referral from their family
physician or other physician are asking for trouble, and rapidly acquire an out of control
drug addict population.
REPORTING PHYSICIAN FRAUD
HOW TO REPORT OVERCHARGING TO AUTHORITIES:
Gather the information about the surgery center from the list below (address, name,
etc), print out the complaint form for the attorney general's office (click here) and
send to the attorney general’s office referencing Indiana State Code 844 IAC 5-2-9(a)
and (b). This is the reference for the Indiana state law preventing physicians from
charging excessive fees. Notify your insurer by calling the number on the back of your
insurance card or from the insurance fraud hotline list below, and ask the operator to
permit you to talk to the appropriate person about insurance fraud. If your insurance is
not listed, then contact member services. Most importantly, inform your referring
physician (frequently a family physician or internist) of the massive overcharge or
proposed excessive charges so they will not make the same mistake again. If the
referring physician continues to refer you to such facilities and physicians that
massively overcharge, tell the physician you do not wish to ever be referred to these
places since they are unaffordable, and ask him to note that on your chart.
HOW TO REPORT THEFT BY DECEPTION TO AUTHORITIES:
If the physician failed to tell you in writing that he owned part of the surgery center
or if he did not inform you that you could be referred to another health care facility this
is fraud . You would have had to sign a specific form in the physician’s office for this
purpose and he is required to keep this on file. If this was not done or he did not in
writing give you the option to be referred to another facility, you may report the
physician to the attorney general (click here for the form) referencing Indiana law IC
25-22.5-11-3
If the physician is defrauding you by over-utilization such as scheduling all at one
time a “series of 3 injections” without each time evaluating the success of each block or
repeating injections over and over that did not work even temporarily, or scheduling a
spinal cord stimulator implant or radiofrequency procedure without at least 50% pain
relief during the trial implant or injection, etc, then this constitutes both insurance fraud
and a violation of the medical practice act of Indiana. False advertising, including
exaggerated expected degree of relief of pain or length of time the injection or
procedure will last is also a violation of the same law and should be reported to the
attorney general’s office (click here for the form) and the insurer. (eg. If a physician
says an epidural injection will last up to a year or says the range is 1-24 weeks this is
not fraud, but if he says the injection should give relief for a year or more this is fraud.
If he says a radiofrequency neurotomy will last indefinitely or will “fix” the problem,
this is fraud). If a nurse practitioner, physicians assistant, or physician is billing you for
services not provided such as upcoding an office visit to a CPT code ending in “4 or 5”
for a 15 minute visit, this is probably fraud unless a complete physical exam is
performed on each visit of your heart, lungs, thyroid, abdomen, etc. If a nurse
practitioner or physician’s assistant are not in-network, but the physician is, and you
are denied the ability to see the physician or are shunted to the out of network PA or
NP, this may be both insurance fraud and theft by deception. For all the situations
above, a complaint may be filed with the attorney general’s office and the insurer.
Indiana Law IC 25-1-9-4 should be referenced in the complaint.
If the physician waives your responsible amount that insurance will not pay as an
inducement to have procedures or surgeries while having your insurance company for
the overcharges, this is insurance fraud and should be reported to the insurer and the
attorney general’s office as above and to the Indiana Department of insurance at:
IDOI
Attn: Consumer Services Division
311 W Washington Street, Suite 300
Indianapolis IN 46204-2787
Or Fax to:
317-234-2103
.
HOW TO REPORT AN ILLEGAL OPERATION: If the surgery center is not
clearly marked as a surgery center on the outside and inside of the building, or if the
physician is using a common waiting room or staff for both surgery and office patients
at the same time, this is an illegal operation. Call the acute care division of the Indiana
Department of Health. They regulate and license ambulatory surgery centers and you
may lodge a complaint with them by emailing complaints@isdh.in.gov AND THEN writing
Indiana State Department of Health
Division of Acute Care
2 North Meridian Street, 4A
Indianapolis, IN 46204
AND it is suggested to call one of the following numbers stating up front that you wish
to lodge a complaint against a surgery center (ASC).
(317) 233-7474 (Acute Care Receptionist)
(317) 233-1325 (ISDH Main Switchboard)
AND
Contact the Office of the Inspector General, Federal Government via email at
HHSTips@oig.hhs.gov stating the facility sees medicare patients and may be
defrauding them through illegal operation.
REPORTING MEDICARE FRAUD
Before contacting the Medicare claims processing company, carefully review the facts as you
know them and as shown on the Medicare Summary Notice. Write down:
•The provider's name and any identifying number you may have.
•The item or service you are questioning.
•The date on which the item or service was supposedly furnished.
•The amount approved and paid by Medicare.
•The date of the Medicare Summary Notice.
•The name and Medicare number of the person who supposedly received the item or service.
•The reason you believe Medicare should not have paid.
•Any other information you may have showing that the claim for the item or service should
not have been paid by Medicare.
If you plan to write rather than call, clearly state at the beginning of your letter that you
are filing a fraud complaint. This will help to ensure that your complaint is forwarded to the
fraud unit.
By Phone: 1-800-HHS-TIPS (1-800-447-8477)
By Fax: 1-800-223-2164
(no more than 10 pages please)
By E-Mail: HHSTips@oig.hhs.gov
By Mail: Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026
REPORTING MEDICAID FRAUD
■Billing for services not provided
■Billing for unnecessary treatment or testing
■Billing for medical services that are actually provided by unlicensed or excluded personnel
■Billing for lengthy counseling sessions when only short sessions are provided
■Making a patient pay more than a Medicaid-approved co-payment for services
To report such fraud you may click here to go to the Indiana Medicaid reporting
website or you may call the Medicaid Fraud Control Unit at 800.382.1039.
REPORTING INSURANCE FRAUD:
Anthem (Indiana): 1-877-283-1524 Fraud Hotline
Assurant Health : 1.800.800.3830 Ext. 8324
SIHO Member services: (800) 443-2980
Cigna:call 1.800.667.7145 or e-mail: specialinvestigations@cigna.com
Aetna: email aetnasiu@aetna.com
Humana, United Health Care, Sagamore contact the customer service number on your
insurance card
Surgery Centers in the Area:
Columbus Pain Institute LLC (assumed name) aka XRS LLC (legal name)
(located inside the Wellspring Pain Solutions building)
2400 NORTH PARK, SUITE 20 COLUMBUS, IN 47203
Status as of 7 1 2010: Not accredited by JCAHO, AAAASF, AAAHC, or HFAP or by any
accrediting agency. Not a member of the Chamber of Commerce
Owner: Registered agent with Secretary of State of Indiana:
ANDREW ROBERTSON, 12880 W SAWMILL RD,
COLUMBUS , IN 47201
Additional local medical staff privileges: Columbus Surgery Center
and Columbus Regional Hospital
Columbus Surgery Center
(located inside the Columbus Surgery Center/SIO/CRH PT Building)
940 North Marr Road, Suite B • Columbus, Indiana 47201
Accredited by AAAHC Member of the Chamber of Commerce
Owner: Genesis (approximately 13 physicians) and Columbus Regional Hospital,
each 50% owner. Additional local medical staff privileges: Columbus Regional Hospital
for most physicians, some have privileges at Schneck Medical Center, St Vincent’s North
Vernon, and St Francis
Pankratz Eye Institute
3135 Middle Rd, Columbus, IN 47203
Registered agent: TIMOTHY H WALL, 8465 KEYSTONE CROSSING BLVD STE 160,
INDIANAPOLIS , IN 46240
SOUTH CENTRAL SURGERY CENTER LLC
5002 E STATE ROAD 44
FRANKLIN, IN 46131
Administrator: NANCY PENN, RN,DON
License Number : 10-003073-1
FRANCISCAN SURGERY CENTER LLC
(located inside the 5255 Building)
5255 E STOP 11 ROAD, SUITE 100
INDIANAPOLIS, IN 46237
Administrator: STEPHEN WHEATLEY
INDIANA ORTHOPAEDIC SURGERY CENTER
(located inside the 5255 Building)
5255 E STOP 11 ROAD, SUITE 110
INDIANAPOLIS, IN 46237
Administrator: JANE KELLER
INDIANA SURGERY CENTER-SOUTH
(located inside Community South Hospital)
1550 E COUNTY LINE ROAD
INDIANAPOLIS, IN 46227
Administrator: MARK WALKE
Other ways to lodge complaints about overcharging or
fraud
1. Board of Medical Licensure E-mail: pla3@pla.IN.gov (in addition to attorney
general report)
2. Better Business Bureau online complaint form https://odr.bbb.
org/odrweb/public/complaintlink.aspx
3. National Insurance Crime Bureau (NICB). 800-835-6422. You are allowed to
keep your identity anonymous when reporting fraudulent information
4. Report to Insurance fraud online http://www.insurancefraud.com/node/5
5. Email “The Republic” newspaper KJohannesen@therepublic.com
6. Call 6- the TV Channel 6 Investigative Line: You can call the WRTV news desk at
(317) 269-1440, TheIndyChannel Web staff at (317) 269-1476, or send us mail at:
WRTV (or TheIndyChannel.com) 1330 North Meridian Street Indianapolis, IN 46202-
2364