A semi-brilliant scheme to fool a health insurance provider by claiming 20 fake brain surgeries has been busted by the federal prosecutors. A group of people scammed Group Health Insurance out of over $300,000 over four years.
Most notably, city employee Stanley Canella claimed he, his wife and four sons had nine brain surgeries during that time. The NY Times says it's unclear whether it's the "nine operations" that "piqued the interest of federal investigators" or if it was that "all four members of the family received insurance reimbursements for the same surgery on the same brain." Did the investigators ask neighbors if the family seemed to have especially large bandages around their heads? GHI's investigators were actually the ones to find the odd billing and tell the feds; a GHI spokesperson told the Times, "We’re glad the United States attorney’s office was able to make a case."
The scam worked this way: One person, who worked at GHI, got his hands on post-operative reports from two patients who had brain surgery, and then used them to accompany dummy claims. Canella is still on lam, for fraud of over $142,000; he and the other participants, who are from Manhattan, Mount Vernon, and Staten Island, will face between 30 and 90 years for mail and health care fraud.