Medical Mutual of Ohio Issues Fraud Report

Nearly $5 million in fraudulent activity uncovered for year 2007 CLEVELAND, March 5 /PRNewswire/ -- Armed with some nifty software and asmall, but ambitious staff, John Shoemaker, manager of Medical Mutual ofOhio's Financial Investigation Unit uncovered $4.9 million in fraudulentactivity for the year ending 2007, according to figures just released bythe Cleveland-based health insurer. On average, Shoemaker and his staff investigate 120 cases of potentialfraud per year and have produced more than 700 indictments in 20 years.Over the past five years, Medical Mutual has reclaimed more than $20million from fraudulent activity. The costliest of all crimes, the National Health Care Anti-FraudAssociation (NHCAA) estimates more than $100 million is lost every day tohealth insurance fraud. Shoemaker and the NHCAA said everyone pays forhealth insurance fraud and there are ways consumers can help prevent it: Protect your health insurance card like your credit card. In the wronghands, a health insurance card is a license to steal. Don't give policynumbers or other identifying information to door-to-door salesmen ortelephone solicitors. Read your policy and benefits statements. Read your policy, Explanationof Benefits (EOB) statements and any paperwork you receive from yourinsurance company. Make sure you actually received the treatments for whichyour insurance was charged, and question suspicious expenses. Beware of "free" offers. Offers of "free" services are often fraudschemes designed to bill you and your insurance company illegally forthousands of dollars of treatments you never received. If it sounds "toogood to be true," it usually is. Report fraud quickly. Don't put it off. Call your insurance companyimmediately if you suspect you may be a victim of health insurance fraud. According to the NHCAA, health insurance fraud is responsible forupwards of five percent of the total cost of all health care in the UnitedStates annually. "Our mission is to simply try to help hold the lineagainst higher health care costs," said Shoemaker. Shoemaker said the fraud-sniffing software plays a huge part in nabbinghealth insurance fraud artists by flagging irregularities in insuranceclaim filings. "This software helps us focus efforts on cases most likelyto have fraud," said Shoemaker. "This year, the company has almost fivemillion reasons to believe our staff and software are working quite welltogether." Founded in 1934, Medical Mutual of Ohio is the oldest and largesthealth insurance company based in Ohio. The company serves its customersthrough high-quality, affordable group and personal health insurance plans,and third- party administrative services to self-insured group customers.Based in Cleveland, Medical Mutual also has offices in Columbus,Cincinnati, Toledo, Akron, Dayton and Youngstown. For more information,visit the company's award- winning Web site at MedMutual.com.