Two true tales of olden times.
1. In 1989 I left the Medicare intermediary, Blue Cross of California (BCC), to become a consultant for Brecker, Brewster, Grove & Associates, a home health care business consulting firm.
About then a hospital in Sacramento hired a former intermediary auditor (from Aetna not BCC) to advise them on how to handle a Medicare overpayment of approximately $200,000. He advised them to return the monies to the Medicare program (duh). They choose to keep the monies and await any specific later request from the government.
The consultant filed a Qui Tam or false claims action against the hospital. The hospital was fined $2.6 million of which he got $650,000. He retired from the consulting business.
I thought my new career and profession was over before it got started because of the press reports;
1. We were both former Medicare intermediary auditors.
2. We both lived in Petaluma, California.
3. Our last names were both BOYD.
What are the odds of these coincidences? Am I lucky my career was not ruined by any confusion?
2. The BCC provider audit department like “CMS” was on a fiscal year ending September 30th of every year. I was there from 1977 to 1989 and every September was the month of Hades as we rushed to finalize cost report audits and final settlements. Often we would complete the reports in early October but date them in September. I would get calls from providers saying their NPR was dated 9/28 but they got it on 10/15 or they got the proposed adjustments, dated 9/27, on 10/19 and had lost two weeks of their response time (I was usually kind enough to extend the deadline).
About 1993 a BCC senior auditor had a Qui Tam against BCC for cheating on the deadlines and BCC was fined $6 million of which the auditor got about $1 million.
Why didn’t I think of that?