I've got a real fraud case for you...
My ex wife was on the birth control pill.
Every month, she would go to the Womans health center, to get a new package of pills.
As they catored to low life pieces of shit, payment was required at the time of service.
And since birth control pills weren't covered by my insurance, it wasn't a big deal.
4 years passed, and it was the same way every month.
My ex was always going to the doctor for something, so I had a stack of
"explaination of benefits" forms several inches thick. I never looked at them.
Well, one day I did.
And it happened to be a claim from the woman's health center.
For something like 35 dollars worth of outpatient medication.
And my insurance company was paying $20 back to them.
(or whatever it was)
I called the womans health center and asked for an itemized billing statement of our account
from the time of creation. They strongly objected. I made up a story about tax problems,
and that we had claimed medical expenses, and the auditor needed the information. I said that
they can either mail them to me, or I'd send the IRS auditor to them. Made no difference to me.
When I got the itemization in the mail, it took me a while to decipher it and figure it all out.
They were getting checks from my insurance company, crediting my account, then billing my
account under a generic "miscellaneous code". Pretty slick. Someone was pocketing a bunch
of money from me, and probably hundreds of other patients.
SO, what to do. I could call my insurance company and report the fraud.
The insurance company would try to get their money back.
OR, I could demand the money from the clinic.
It wasn't my money, since insurance doesn't cover the pill.
But it wasn't the clinics' either, because they got it fruadulently.