CINICO facing potential home-care fraud

| 15/06/2016 | 19 Comments
Cayman News Service

Lonny Tibbetts, CEO of CINICO

(CNS): The CEO of the government-owned insurance company, CINICO, has revealed that it is at risk of fraud over home-care benefits given to former hospital patients. Lonny Tibbetts said CINICO has reported at least one case to the RCIPS and that there may be more of people and doctors misrepresenting the facts about their condition and healthcare needs. Answering questions Tuesday in Finance Committee, mostly from East End MLA Arden McLean, Tibbetts admitted some patients or their guardians were attempting to defraud CINICO by submitting false documents or letters from physicians exaggerating their healthcare needs.

Home-care benefits, Tibbetts explained, are paid directly to patients who are released from hospital but still need health care at home. He said it was cheaper than keeping people in hospital for long periods, freed up beds for more acute patients and helped in the recovery as patients improve quicker in their home environment. He said the benefit was paid only for health related care and it was not an assisted living payment.

Indicating that specific criteria must be met in order to get the benefit, which is designed to cover the cost of a health care professional, Tibbetts said CINICO was checking the qualifications of carers employed directly or through agencies when patients submitted invoices in order to get the payments but he admitted that there had been fraudulent claims made by healthcare professionals and patients.

He said the decisions about who gets what and why were made by a CINICO committee on a case by case basis, which was verified by doctors. He said no one was receiving indefinite care but every six months the patients were required to reapply and the cases would be reassessed to see it they were still in need. Admitting that some physicians might not always be as accurate as possible, he said that CINICO was monitoring claims closely and the government company reserved the right to verify the condition of any individual receiving benefits and claims made by them or their doctors.

McLean queried if any doctors have been prosecuted because one did not have to be “a genius to see fraud coming” in such circumstances where doctors were sending letters that were not completely accurate, allowing people to access benefits paid for by public funds. But Tibbetts said that CINICO was aware of and being vigilant about the possibility of fraud.

“We have received fraudulent documents before and we have an active case now with the RCIPS,” he said, and spoke of cases where signatures have been forged. He made it clear that CINICO would stop payments where there were concerns that care-givers, doctors or patients were not being truthful, but said the majority of the claims submitted were valid with properly completed applications. However, if CINICO finds anything that seems incorrect it was investigated, Tibbetts noted.

When McLean asked if a cosmologist would be qualified to provide the top-level care, implying that someone receiving home health care benefits was employing one, Tibbetts said he did not know about that case but maintained that contracts and qualifications of carers were vetted.

Tibbetts said there had been cases where benefits were not paid when carers did not meet qualification requirements. He said that CINICO did not accept liability for the care its members acquired with their benefit but it was in the best interests of the patient to get a qualified professional person.

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Category: Government Finance, Health, Politics

Comments (19)

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  1. Anonymous says:

    This reminds me of something I heard about people who receive social services money and after they die the family conveniently forgets to inform this and keep receiving the money. If this is true some heads need to roll!

  2. Anonymous says:

    What about the many gastric bypass that have taken place with majority of those landfill workers?

  3. Anonymous says:

    A normal insurance company would check claims with their own doctors/support staff. Guess we are not in Kansas toto

    • Anonymous says:

      More investigations are still needed. Why do I hear nurses talking about patients that can’t be helped any longer but a call to MLA’s and the patient way overstays. And we all foot the bill when they don’t end up paying their bill.

  4. Anonymous says:

    Does CINICO pay for breast augmentation? Just asking.

  5. Anonymous says:

    Thank you Mr. Tibbetts for being vigilant to the fraudsters that go about committing these acts against CINICO. Great work Sir, we are very pleased to see you are on top of these things. The government should appoint you their National Investigator of fraudsters and oversee other agencies and depts. because some others are neck deep in fraud and they do not have the the personnel who is willing to deal with it the way you do. Hopefully a judge will throw the book at the current case the RCIPS has with them.

    This is exceptional news we have at least one Govt. business doing their job.

    • Anonymous says:

      2:58, this is an ironic post, we presume?

      • Anonymous says:

        Not anymore ironic than yours.

      • Anonymous says:

        I listened to the debate. At no time was anything stated that anyone got away with it. The fraud was identified and the application suspected to be fraud was handed to the police. The CEO also said all applications are vetted. The media must have a difficult time understanding what was said.

        CNS: I think the problem here is with your reading comprehension.

  6. Anonymous says:

    Cosmologist?

  7. Anonymous says:

    Treason!

  8. Anonymous says:

    this is not a revelation. its a way to come forth to try avoid the inevitable coming to light.

    • Anonymous says:

      We need a total mindset change! This abuse comes from the entitlement handout society that our politicians have created. Our forefathers would never condone such a systematic acceptance of cheating the people at every turn!? “A call to a MLA” yup, it’s all about the votes and keeping cousins happy. This leads to abuse of social welfare, the long unemployment lines, and the breakdown of our society.
      All these frauds must be exposed and also the olive branch of employment so the indigent class will stop looking for loopholes and handouts and literally get “back on their feet!”

  9. Anonymous says:

    What…no more free flights to Miami for shopping trips????!!!! Shocking!!!

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