hearing aid insurance fraud

Father and Son Sentenced to Prison in $27 Million Dollar Hearing Aid Insurance Fraud Scheme

A father and son duo that submitted more than $27 million in fraudulent hearing aid claims to insurer Blue Cross and Blue Shield of Texas was sentenced to eight and seven years in federal prison, respectively, announced U.S. Attorney for the Northern District of Texas Erin Nealy Cox.

Terry Lynn Anderson, 69, and Rocky Freeland Anderson, 38, of Dallas, were convicted on multiple counts of health care fraud and aggravated identity theft in March 2018 following a 10-day jury trial before U.S. Chief District Judge Barbara M.G. Lynn.

The elder Mr. Anderson was sentenced Wednesday to eight years in federal prison and ordered to pay nearly $13.7 million in restitution to Blue Cross and Blue Shield of Texas; he was also ordered to forfeit a 300-acre ranch in Valley Mills, Texas, three vehicles, and more than $3.1 million seized from nine financial accounts. His son was sentenced to seven years in federal prison and ordered to pay more than $8.4 million in restitution to Blue Cross.

“In flagrant disregard for the law, these defendants submitted claims for equipment they knew patients neither needed nor wanted, just to line their own pockets. This sort of fraud impacts healthcare costs for patients who actually need coverage and we will continue to prioritize these cases.”

–U.S. Attorney Nealy Cox

According to evidence presented at trial, the defendants defrauded Blue Cross by submitting claims on behalf of American Airlines employees for hearing aids that were not needed and, in many cases, never dispensed to the patient.

The fraudulent claims were submitted through Anderson Optical & Hearing Aids Center, the defendants’ family-owned business with locations in Arlington and Bedford.

 

Fraudulent Hearing Aid Claims

 

To increase the number of claims they could submit to Blue Cross, the defendants engaged in marketing practices, promising patients 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 patients that they had slight to mild hearing loss and required them to sign an order for hearing aids in order to receive the free glasses.

The defendants promised patients that the hearing aids would be provided to them at no cost, and that Anderson Optical & Hearing would waive any applicable copayments, coinsurance, or deductibles. The defendants also offered patients $100 gift cards in exchange for referring family members and coworkers for free hearing tests.

In 2012, the pair brought their fraud scheme into American Airlines’ airport facilities and started offering free hearing tests to aircraft mechanics and fleet services clerks in maintenance hangars and employee breakrooms. Attracted by the offer of free sunglasses, the pair often had long lines of employees waiting to be tested.

 

Incomplete Evaluations

 

An expert witness who testified for the government explained that the cursory screening tests the defendants performed, which witnesses described as lasting 3-5 minutes, were incapable of producing results upon which one could make a legitimate decision to dispense hearing aids. Witnesses from Blue Cross testified that these cursory screening tests also failed to comply with Blue Cross’s medical policies related to the evaluation of hearing impairment.

The evidence showed that, in November 2013, Blue Cross conducted an audit of Anderson Optical & Hearing and requested copies of patient records for certain American Airlines employees and their dependents. On January 6, 2014, the Texas Department of State Health Services-Professional Licensing Unit began investigating a complaint it had received concerning the Andersons.

In February 2014, when given the opportunity to respond to the complaint, the defendants submitted several patient records to the Professional Licensing Unit, including some of the same patient records that had been collected by Blue Cross. The patient records submitted to the Professional Licensing Unit had altered test scores and additional notations that were not present when the same records were submitted to Blue Cross in November 2013.

During the period of the fraud scheme, Anderson Optical & Hearing submitted claims to Blue Cross for hearing aids on behalf of American Airlines employees totaling more than $27 million. 

As a result of the claims, Blue Cross paid Anderson Optical & Hearing more than $16.7 million.

 

Source: US DOJ


1 Comment

  1. They sure sounded very professional and had it all set up! Democrats!
    In Los Angeles, there was a very elaborate con job set up by some Audiology offices, and they were tracked by the FBI, and then prosecuted!

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