Major Insurers Are Scamming Billions from Medicare, Whistle-Blowers Say

Bloomberg April 12, 2022
John Tozzi

Billing for illnesses that don’t exist, like prostate cancer in a woman.

Teresa Ross had been raising objections at work for months when her bosses brought in a psychologist hoping to make her question her own sanity.

A longtime manager at a Seattle health plan called Group Health Cooperative, Ross had opposed changes to the way the company billed Medicare. With the help of a new vendor, the insurer identified new diagnoses for patients, bringing in millions of extra dollars from the government. Ross insisted much of it was fraud. She says she was cut out of meetings.

Then she was invited to one with the psychologist. He asked how she was feeling and revealed that a senior executive had...

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