Father and Son Charged in $16 Million Health Insurance Fraud Scheme

[nitpicker]

https://www.justice.gov/usao-ndtx/pr/father-and-son-charged-16-million-health-insurance-fraud-scheme

Department of Justice
U.S. Attorney’s Office
Northern District of Texas

FOR IMMEDIATE RELEASE
Thursday, April 20, 2017

Father and Son Charged in $16 Million Health Insurance Fraud Scheme

DALLAS – An indictment returned by a federal grand jury in Dallas this week charges Terry Lynn Anderson, 66, and Rocky Freeland Anderson, 36, of Dallas, with offenses related to their participation in an insurance fraud scheme, announced John Parker, U.S. Attorney for the Northern District of Texas.
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The indictment alleges that Terry Anderson was the owner of Anfree Incorporated, a Texas corporation that did business as Anderson Optical & Hearing Aids Center (Anderson Optical & Hearing). Terry Anderson co-operated Anderson Optical & Hearing with his son, Rocky Anderson, and both are licensed by the State of Texas as Fitters and Dispensers of Hearing Instruments. From January 1, 2011 through November 8, 2016, the defendants devised and executed a scheme to defraud Blue Cross Blue Shield of Texas (BCBS) by submitting claims for hearing aids that were not needed and, in many cases, not delivered to the BCBS subscriber. To increase the number of claims they could submit to BCBS, the defendants and their coconspirators engaged in fraudulent marketing practices.

For example, the defendants promised BCBS subscribers a free pair of high-end sunglasses or a free pair of prescription eyeglasses in exchange for taking a free hearing test. At the conclusion of these hearing tests, the defendants told subscribers that they had slight to mild hearing loss and required them to sign an order for hearing aids in order to receive the free sunglasses or prescription glasses. The defendants promised subscribers that the hearing aids would be provided to them at no cost, and that Anderson Optical & Hearing would not require the subscriber to pay any applicable copayment, coinsurance, or deductible. The defendants also offered BCBS subscribers $100 gift cards in exchange for referring family members and coworkers for free hearing tests.

The defendants took advantage of BCBS plans offered to employees of American Airlines because prior to 2014, the American Airlines insurance plans administered by BCBS had no maximum limit on the cost of hearing aids and allowed subscribers to obtain hearing aids once per plan year. In 2013, approximately 84.6% of Anderson Optical & Hearing’s total income came from BCBS and 99.7% of the BCBS payments were based on claims submitted for American Airlines employees and their dependents.

The defendants failed to conduct hearing tests that complied with BCBS’s medical policies related to the evaluation of hearing impairment. Many of the hearing tests were conducted in an employee break room at DFW Airport and lasted less than five minutes. The defendants then submitted claims to BCBS for reimbursement for hearing aids before dispensing hearing aids to the subscriber, and in some cases for hearing aids that they never delivered to the subscriber. The defendants kept lists of subscribers who had not received hearing aids despite BCBS having paid the claims. One such list contained 103 names.

The indictment also alleges the defendants falsified patient records, forged patient signatures, and attempted to dispense hearing aids and collect deductibles and coinsurance years after the subscriber was offered a free hearing test and free hearing aids.
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Anderson Optical & Hearing submitted claims to BCBS for hearing aids on behalf of American Airlines employees totaling more than $27 million, the vast majority of which were fraudulent. As a result of these claims, BCBS paid Anderson Optical & Hearing more than $16.7 million.
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