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UNIVERSITY HOSPITALS OF CLEVELAND CHEATED CUSTOMERS IN A FRAUDULENT TRIPLE-BILLING SCHEME, BLUE CROSS & BLUE SHIELD OF OHIO CHARGES IN AN ACTION FILED TODAY; 'FRAUD SQUAD' FINDS SCAM

 CLEVELAND, July 8 /PRNewswire/ -- A fraudulent triple-billing scheme and other overbillings by University Hospitals of Cleveland (UHOC) cost Blue Cross & Blue Shield of Ohio (BCBSO) and its customers more than $2.4 million, an action filed today by the state's largest health insurer claims.
 Charging that University Hospitals "intentionally and systematically cheated" customers, the company seeks in excess of $8 million damages, and interest.
 This systematic pattern of cheating was laid bare by the insurer's Financial Investigations Department, known familiarly as the "Fraud Squad," following numerous customer complaints to the company's popular and heavily used Fraud Hotline, the petition says.
 It also says that, because of the fraudulent scheme, the outpatient psychiatric benefits of some BCBSO customers were depleted three times faster than they should have been.
 Alerted by the "Fraud Squad," Blue Cross Internal Audit Department began to examine other UHOC charges and claims it caught University Hospitals double-billing for some emergency services, billing BCBSO for research excluded from coverage, and found the hospital had made changes in its lab processing system which caused BCBSO to be overbilled by $200,000.
 On top of that, Blue Cross claims UHOC is stonewalling the release of further relevant data to which it is contractually entitled, and that hospital officials have refused to so much as meet with representatives of BCBSO.
 Blue Cross cites language in its current contract with the hospital which says, "...BCBSO may conduct audits of the records necessary" to ensure the hospital is in compliance with provisions of the agreement.
 BCBSO's action, filed today in Cuyahoga County Common Pleas Court, counters a lawsuit by University Hospitals late last month alleging BCBSO deceived its customers about hospital discounts.
 Blue Cross is on record as replying that this allegation is the hospital's way of attracting attention to the gist of its suit -- that BCBSO is withholding payments to the hospital. Blue Cross is also on record as saying that payments have been withheld to recoup the money University Hospitals billed fraudulently.
 BCBSO's petition says the "Fraud Squad" discovered that, unbeknownst to BCBSO, University Hospitals "had engaged and was engaging in an illicit scheme to triple bill BCBSO for outpatient psychiatric care...
 "Specifically, whereas UHOC was permitted to charge BCBSO approximately $60 per hour for outpatient psychiatric care...UHOC was, in fact, charging BCBSO approximately $180 per hour for such services.
 "As a result of this scheme, BCBSO was being systematically cheated out of approximately $120 per hour for each hour one of its certificate holders was receiving outpatient psychiatric care...and each certificate holder...was having his or her psychiatric benefits depleted three times faster than they should have."
 The action also says, "In January 1992, UHOC offered to settle BCBSO's claim...by offering a settlement in the amount of $600,000," the Blue Cross petition notes. "BCBSO rejected that settlement proposal and, once again, requested that UHOC cooperate and provide it with information...as it was required to do under the terms of the Agreement."
 And it adds that on Nov. 11, 1992, BCBSO advised UHOC that as a result of overcharges occurring since 1988, UHOC owed BCBSO $2,440,516.
 Blue Cross & Blue Shield of Ohio's "Fraud Squad" was formed in 1983 to uncover dishonest practices by hospitals, physicians and others. In that time, its work has resulted in more than 300 criminal indictments, with a conviction rate of more than 93 percent.
 Its work has saved the company and its customers, on average, more than $2 million per year -- a total of more than $23 million in 10 years.
 -0- 7/8/93
 /CONTACT: Paula A. Slimak of William Silverman & Company, 216-696-7750, for Blue Cross & Blue Shield of Ohio/


CO: Blue Cross & Blue Shield of Ohio; University Hospitals of Cleveland ST: Ohio IN: INS SU:

KL -- CL011 -- 9588 07/08/93 15:01 EDT
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Date:Jul 8, 1993
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