Pending insurance fraud case not the norm, authorities say

Badly burned by hot grits during a domestic dispute, Willie Frank Hogan went to a medical clinic in 2009.

Fearing that there was a warrant out for his arrest, however, the 39-year-old Macon man used his brother’s identity — and insurance card — at the clinic, authorities say.

“I really didn’t care,” said Hogan’s brother, Darran Jerome Hogan.

He said he gave his identification to his brother because he needed help.

“All I could see was pink ... on the side of his face,” Darran Hogan said.

But Willie Hogan could now face from two to 10 years in prison if he’s convicted of insurance fraud, Bibb County prosecutor Angela Manson said.

Manson said cases such as Hogan’s are rare in Bibb County.

Typically, the cases she’s prosecuted involve people who have claimed losses that either didn’t happen or didn’t happen the way a person claimed they happened.

She said Hogan’s case is the first one she’s handled with one person allegedly trying to use another person’s insurance card.

“I’m sure it’s a lot more common than is recognized,” Manson said. “This one was caught.”

Workers at The Medical Center of Central Georgia say they see similar cases once every few years.

Although the country has been hard hit by recession, Jane Gray, the Medical Center’s assistant vice president for revenue, said she hasn’t seen an increase in patients trying to use other people’s insurance.

For one thing, the hospital provides treatment for patients without insurance, she said.

But when a person tries to use another person’s health insurance, the fraud can be hard to catch, Gray said.

It’s especially difficult in cases in which patients receive treatment, but aren’t admitted to the hospital, she said.

“We’re exposed to them for such a short amount of time,” Gray said.

Often, patients trying to commit fraud are using family members’ identities, making it even harder to catch.

Although the hospital asks patients to verify addresses and phone numbers, family members trying to commit fraud have access to the information, Gray said.

As a safeguard, the hospital requires patients to provide some form of photo identification, which is compared to the insurance information. The photo ID is scanned and stored electronically in the hospital’s computers for future visits.

If patients are caught committing identity fraud, the fraud is reported to the hospital’s compliance and legal department or to the hospital police.

The information also is passed along to the insurer, said Kim Whitley, the hospital’s registration director.

“It doesn’t impact the patient’s care,” she said. “They still receive care while they’re here.”

In Willie Hogan’s case, employees at the Medical Center’s clinic on Gray Highway refused treatment, Darran Hogan said.

Phone calls to Willie Hogan were not answered this week.

Janie Poulnott, a hospital spokeswoman, said she couldn’t comment on the open criminal case because of pending litigation.

Willie Hogan is accused of signing his brother’s name on a consent form, according to a Macon police report.

Darran Hogan said he didn’t press charges, but his brother was charged with identity theft, according to the police report. Willie Hogan was indicted March 30.

“I couldn’t get mad at him for trying to get help,” Darran Hogan said.

Dangerous consequences

Health insurance fraud has the potential for long-lasting financial — and medical — complications, Gray said.

Medical records at the Medical Center and some doctors’ offices are now digitally linked to registration information, including a patient’s identity and health insurance information, she said.

“The medical information implications are the most serious,” Whitley said.

Whitley said it’s possible that the patient committing fraud could be treated for conditions listed on the victim’s medical record.

“They could be treating you for an ailment you don’t have,” she said.

It’s also possible that insurance companies could deny payment for a victim’s claim based on services that the person committing fraud receives, Gray said.

Several years ago, for example, The Medical Center treated two women who gave birth four months apart. One of the women tried to steal the other woman’s identity to receive medical benefits, Gray said.

“You can’t have two full-term babies in a four-month period,” Whitley said.

Gray said fraudulent information on a person’s medical record can cause complications when they try to qualify for future health insurance or buy life insurance.

“It could follow them throughout the rest of their lives,” she said. “It creates a lot of headaches trying to straighten it all out.”

After receiving medical treatment, patients should carefully review the explanation of benefits statements they receive in the mail to verify the date of service and the services they received, Gray said.

If a fraudulent claim is listed, patients should call their insurance company and the health care provider to try and get the record corrected, she said.

To contact writer Amy Leigh Womack, call 744-4398.