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

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

Teresa Ross filed a sealed whistleblower suit against the company, now part of Kaiser Permanente, after she says she discovered that they were fraudulently inflating how sick their members appeared to be to get higher payments from Medicare.

Teresa Ross filed a sealed whistleblower suit against the company, now part of Kaiser Permanente, after she says she discovered that they were fraudulently inflating how sick their members appeared to be to get higher payments from Medicare.

Photographer: Jovelle Tamayo/Bloomberg

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.