Case Study Dr. Traveler—Recap

Case History: Dr. Traveler is a licensed MD with a philanthropic edge in providing free healthcare examinations to the underinsured. The primary healthcare continuum market players, in this case example, are defined as a licensed medical doctor, working in a free-standing clinic not affiliated with any other provider, taking care of privately insured, Medicare, and Medicaid patients. The progression of this case notes that secondary victims exist. They include the billing company, who is extending resources on collecting claims that have already been denied, and, in some cases, facilitating the reversal of claims on services that were never received by a patient. Further, a second business entity, a collection company, was buying fraudulent receivables in which payment would most likely never be received.

Data Highlights: Home health visits in volumes that significantly exceed the realistic number of patients per day, during prohibitive travel conditions, including the treatment of patients with his home address and of those that are deceased. There are also third-party market players, such as the billing company and collection agency, submitting repeated false claims.

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