Friday, August 31, 2012

Medical worker sentenced to year in jail, $472k in insurance fraud case

Here's a press release we issued a few minutes ago:

A medical worker who pretended to be a doctor and submitted millions of dollars in bogus bills to insurance companies has been sentenced to a year in jail and $472,458 in restitution.


Kenneth R. Welling, 45, of Lake Forest Park, was sentenced Aug. 24 in King County Superior Court. He pleaded guilty to seven felony counts of theft in June.

“We found numerous cases in which Welling billed for surgeries that never happened,” said state Insurance Commissioner Mike Kreidler. Kreidler’s office was tipped off to the scam when a patient complained, saying that Welling had tried to bill her insurer $89,000 for six surgeries that never took place.

Welling is a registered surgical technologist and sole proprietor of Shoreline, Wash.-based Alpine Surgical Services. His license allows him to perform tasks like preparing supplies and instruments, passing them to the surgeon and preparing basic sterile packs and trays. But after patients had procedures done, he would often submit large bills with codes listing himself as a doctor or physician’s assistant. He is neither. Sometimes he would include post-operative reports, listing himself as the surgeon.

No evidence was found to indicate that Welling was playing an improper role in actual medical care. The fraud involved billing.

“As far as we could tell, the only time he pretended to be a doctor was when he submitted bills,” said Kreidler.

In one woman’s case, Welling billed $140,323 as assisting surgeon for nine surgeries that never took place. Over a five-year period, he billed another woman’s insurer 107 times for 51 different surgeries, listing himself as the primary doctor. Hospital records show she’d only had surgery twice.

From 2004 through 2011, according to medical records obtained by Kreidler’s Special Investigations Unit, Welling billed five insurance companies at least $4.1 million for services he did not provide. He was paid $461,000.

“Part of the reason he got away with this for so long is that he’d rarely challenge an insurer who paid little or nothing,” said Kreidler. “He’d just send them the bills and hope they’d pay.”

Interesting story about how the Apollo 11 astronauts got life insurance

NPR has posted an interesting story about how the Apollo 11 astronauts sort of self-insured their lives when they headed for the moon.

Rather than try to get conventional life insurance, the three astronauts spent their spare moments during their month of pre-launch quarantine signing autographed envelopes, according to NPR's Chana Joffe-Walt. That way, if they died on their lunar adventure, their families could sell the autographs, which today command up to $30,000 at auction.

To make the autographs more valuable, each was on an envelope that a friend would have postmarked on key days, like the launch date and the date they landed on the moon. Writes Joffe-Walt:
It was life insurance in the form of autographs.
"If they did not return from the moon, their families could sell them — to not just fund their day-to-day lives, but also fund their kids' college education and other life needs," (space historian Robert) Pearlman said.
The life insurance autographs were not needed. Armstrong and Aldrin walked on the moon and came home safely. They signed probably tens of thousands more autographs for free.