Dive Brief:
- Unity, PA resident Kari Richards has been charged with defrauding Highmark's Community Blue Shared Cost plan to obtain more than $600,000 in opiates.
- She was indicted this week in U.S. District Court following charges of healthcare fraud as well as obtaining medication through fraud.
- The woman sought treatment more than 300 times in 16 months at more than 100 hospitals in 11 states. She requested prescriptions for self-inflicted shoulder dislocations and lied about the circumstances, her medical history and medications she had already received.
Dive Insight:
The public record on the case does not reveal the hospitals that were defrauded, or the states in which the alleged fraud took place.
Highmark spokesman Aaron Billger declined to discuss the case with Trib Live, but the site notes that according to a June 3 statement from the company, "Highmark has taken measures to combat fraud, waste and abuse and those efforts had a financial impact of more than $100 million in 2014." The company reports that its investigators closed more than 2,400 cases last year. For this year, it expects the financial impact of its investigations and provider review to exceed $115 million in 2015.