CARMEL, INDIANA, October 13, 2014, It appears that the medical billing gargantuan, Zotec Partners, has been caught red-handed engaging in a systematic practice of profiting from fraudulent Medicare Claims. Unlike how most think of fraud, this process is being conducted through a highly sophisticated approach, which includes; isolating employees, use of temporary outsourced contractors and limiting inter-department communication in order to conceal knowledge. Further Zotec has been able to manipulate inexperienced interns and outsourced employees in India through methodical intimidation and reward (including an annual casino trip). Peter Bonewitz’s position at Zotec Partners involved the design and building of proprietary data warehouses to maintain and store client/patient data. He was privy to many corporate practices, and immediately saw “red flags”.
Mr. Bonewtiz determined that many of the processes and, in fact, a good portion of the Company’s business model was based on a scheme that could be a violation of the federal False Claims Act. He brought his concerns to Zotec’s management, and their Counsel, and was met with a series of “Stonewalling”. Eventually, and in short order, he was terminated. Not being a person to take such abuse when he knew he was in the right, he filed a Civil Suit in the U.S. District Court – Southern District of Indiana. This is an action under the False Claims Act – Retaliation Provision, as amended, 31 U.S.C. § 3730(h) et seq., to correct unlawful employment discrimination against the Plaintiff for engaging in protected activity under this provision. ZotecPartnersFraudConcerns.com.
Zotec Partners is one of the largest medical billing companies in the country, but that does not mean that they are above the law. Should they be allowed to step all over their employees when concerns are raised about improper procedures, and possible fraud? Well, Peter Bonewitz thinks not, and he is not going to stand idly by and watch as firms like Zotec contribute to the ever rising costs of medical care in America. Bonewitz discovered “combined business practices” of foreign outsourcing, using inexperienced intern coders and a lack of appropriate systems for handling disputes.
Mr. Bonewitz states that he learned that medical coders in India and inexperienced interns were coding medical bills in isolation and without physician supervision or involvement. He was concerned that interns were deliberately being given specific types of complex claims to code, including knee surgery that is prone to mistakes. Such complex coding by isolated inexperienced interns could lead to repeated false claims and unnecessary charges to Medicare and could be designed to shield the owners from fraud implications
Peter Bonewitz has conducted an exhaustive investigation into the practices of Zotec Partners, along with CIGNA/Healthspring. He believes they are acting in collusion, and has launched a couple of Blog Sites where he is making his documentation available to the public. These documents will open anybody’s eyes to what is really going on in one of the largest Medical Billing companies in the country. The Zotec Partners case draws attention to the fact that an investigation needs to be conducted of the private medical billing industry so that consumer’s rights are protected and Medicare is not overspent. New consumer laws need to be enacted to ensure that consumers are billed fairly and can dispute a claim properly if the need arises.
According to Peter Bonewitz: “The inability by Medicare Advantage members and Affordable Care Act members to challenge medical billing claims could be costing Medicare/CMS billions while making private insurance premiums rise.” On his new Blog, www.zotecpartnersfraud.com, Peter has gone to great lengths to present a very cogent case backing up his discoveries while at Zotec. Here a visitor will find the basis of his claims of fraud. It involves: Coding The Bills, Sending The Bills, Collections, Call Center Operations, Computer Systems, Automated Phone Systems Development, Psychological Tactics & Hiring Methods, along with a Summary.
Mr. Bonewitz explains that the behavior pattern to defraud includes: Deceptive business practices, Not tracking relevant data in phone and billing system regarding disputes, Isolation of development, Improper medical coding practices by unsupervised interns and Isolated outsourced coders in India, and Lack of event logging processes to track and handle disputes. After review of these documents, one would be hard pressed not to take sides with Mr. Bonewitz.
For more information, please visit: www.ZotecPartnersFraud.com, or ZotecPartnersFraudConcerns.com. You may also visit www.healthfraudalert.com to see fraud concerns Peter Bonewitz has brought to CIGNA’s attorneys.
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