Fraud driving up cost of health care

FRESNO, Calif. (KFSN) -- It is one of the most common types of health care fraud. You get one procedure done but the doctor, bills for a more expensive one. It is driving up the cost of health care, and we are all paying the bill.

"A very complicated, complex procedure is billed to Medicare to generate a higher payment to the provider," said U.S. Postal Inspector Michael Carroll.

It is a growing problem as more and more people live longer and are on Medicare.

"What that ultimately does is it raises medical costs for everyone. In essence, every single person in this country is a victim of this crime," said Carroll.

The story begins with Donald and Shirley Blaine -- a husband and wife duo who formed a company called Respa-Test.

"They were claiming they were doing these very complicated sleep studies which would require overnight monitoring of oxygen, and heart rates, and things like that by a doctor and a staff," said Carroll.

An investigation showed that the procedures that were actually completed in the office were very simple procedures, low-cost procedures that might be billed to Medicare for $3 or $5, according to Carroll.

Postal inspectors say the Blaines would charge Medicare close to $500.

"Everyone's premiums, everyone's costs, everyone's insurance costs, medical costs go up as a result of a fraud like this," said Carroll.

Some advice from Postal inspectors: keep a close eye on your medical and insurance bills.

"If you go to the doctor for a relatively simple procedure and you see something that appears to be much more complicated billed or your explanation of benefits appears to be much higher price than what you think it should have been billed at, then you need to call the insurance company," said Carroll.

The Blaines eventually pled guilty prior to their trial. They were sentenced and ordered to pay $5 million in restitution.