Claims Examiner’s Scam Allegedly Cost California Health Care Provider $7 Million

A former senior claims examiner for the Kaiser Permanente well being plan in California was booked into jail final week on a mail fraud cost stemming from $7 million in invoices that he authorised from 5 non-public investigation corporations.

Federal prosecutors say 48-year-old Michael Albert Quinn was conscious that the non-public investigators did little of the work for which they billed Kaiser. He knew that firsthand as a result of payroll data present that he labored full-time for 2 of the corporations whereas on the similar time working at his full-time place with Kaiser Permanente in Oakland, based on a felony criticism filed by the U.S. District Attorney’s Office for Northern California.

Quinn additionally was paid individually by the distributors — every of them positioned in Reno, Nevada and owned by people recognized within the criticism as Okay.B., R.D. and Okay.R —- for surveillance and different work as a personal contractor. All informed, the distributors paid him $2.78 million from 2007 to 2014, in accordance the criticism.

“Quinn also supervised these same cases as a Kaiser employee,” FBI Special Agent William J. Leoni acknowledged within the felony criticism. “In short, I believe Quinn received the equivalent of two full-time incomes for managing and purportedly investigating the same cases for Kaiser and the PI firms owned by K.B.”

Quinn was employed by Kaiser Permanente authorized division in 1998 to analyze malpractice and premises legal responsibility complaints. Another Kaiser worker grew to become suspicious in 2014 after Quinn informed the worker that he owned two costly properties and had not too long ago bought two high-end vehicles.

Kaiser initiated an audit and found that Quinn had licensed fee of $7 million in invoices for investigative work. By comparability, all the different claims examiners had licensed a mixed $578,345 in invoices from investigations corporations.

The auditors found that the PI corporations did now present any work product to assist the quantities billed, based on the criticism. They did file some investigation studies, however they contained solely biographical info that might simply be obtained by means of subscription-based analysis providers.

What’s extra, Quinn by no means contacted the attorneys assigned to his instances concerning the investigative work that had performed. The auditors seemed into Kaiser’s work-issued laptop computer laptop and located invoices despatched to the distributors by “Michael A. Quinn Investigations” and “Quinn Legal.”

Kaiser terminated Quinn in July 2014.

Quinn is the second Kaiser worker accused of a seven-figure swindle towards Kaiser Permanente. In 2013, Asim Waqar was convicted and sentenced to 33 months in jail on wire fraud and tax evasion fees. Investigators say Waqar, whereas working as a software program venture supervisor for Kaiser in Oakland, paid the spouse of a school buddy in Detroit for work on expertise tasks, regardless that no work was truly performed. He obtained $428,300 in kickbacks for his troubles, based on the U.S. Attorney’s Office.

The East Bay Times reported Friday that Alameda County court docket data present that Quinn had been arrested in 2002 on an embezzlement cost related to his employment as a loss-control specialist for a serious division retailer chain.

Kaiser Permanente issued an announcement saying it filed a civil swimsuit towards Quinn and his associates and was not conscious when it employed Quinn that he had been accused of embezzlement whereas working at Nordstrom.

“Since Kaiser Permanente hired Mr. Quinn more than 20 years ago, we have continued to improve our hiring process, which, of course, now includes various background checks that may not have been commonly used by companies two decades ago,” the corporate stated.

Quinn was being held on the Glen Dyer Detention Facility in Oakland late Friday, based on on-line data. He faces a 20-year jail sentence and a $250,000 wonderful if convicted.

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