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Editor: Mike Bothwell
Profession: Qui Tam Attorney

Category: Settlements and Verdicts

The United States military's health insurance program has been defrauded for more than $100 million during the past 10 years. Doctors, hospitals and clinics in the Philippines have plotted with U.S. veterans to submit false health claims.

So far, there have been seventeen people convicted including U.S. military retirees. Wisconsin based WPS Health Insurance, located in Madison, holds the contract for the processing of many of the claims. WPS has not been named for any wrongdoing.

Tricare, a Pentagon-run program that insures current and former service members and dependents worldwide, is at the center of the case. Health care providers in the Philippines filed claims for medical services which were never delivered and had claims inflated by as much as 2,000 percent. Court records show that the retirees who were involved also shared in kickbacks.

Health Visions executives instructed billers to inflate claims to as much as 233 percent and fabricate diagnoses. The fraud allegations against Health Visions began in 2000 but Pentagon officials waited until late 2005 to cut off payments, according to internal audit reports.