For Immediate Release
October 17, 2013
Catherine L. Bernhard, Senior Assistant Attorney General
(603) 271-2898 or (603) 271-7973 x 235
On October 16, 2013, Mr. Paul J. Loch of Exeter, NH pleaded guilty to one Class A Felony theft by deception in Rockingham County Superior Court. He was sentenced to 1½ to 5 years at the New Hampshire State Prison, a $2,000 fine and required to pay $4,423.10 in restitution. All of the State prison sentence and $1,000 of the fine are suspended for two years upon good behavior.
The theft by deception occurred as part of a billing scheme to obtain medical payment from Anthem Blue Cross and Blue Shield ("Anthem") for durable medical equipment (DME) that was never delivered to patients. In 2010, Anthem conducted an audit of services Mr. Loch provided at Exeter Spine Clinic, the location of his chiropractic practice. As part of the audit, Anthem's investigator discovered that in 2009 and 2010, Mr. Loch billed Anthem for delivery of eleven "Posture Pump 1000" devices. Seven patient accounts were billed for these devices and none of the patients received the DME. Anthem paid each of the eleven claims as they were submitted, believing that the bills from Mr. Loch and Exeter Spine Clinic were accurate. Anthem also conducted an inspection of the office and examined the billing and treatment records. It was discovered that the bills sent to Anthem were not supported by the medical record or the patient schedule. The NH Insurance Department Fraud Unit investigator spoke with the patients, and each of the seven completed an affidavit stating that he or she had never been prescribed or received the DME.
Attorney General Foster and Commissioner Sevigny advise patients to carefully review the Explanation of Benefits (EOB) when they receive them from their medical insurers. Patients should review the EOB to make certain that the provider has accurately charged the medical insurer for their services and that the services listed were actually rendered. Commissioner Sevigny says, "Any consumer with a question or concern about information listed on the EOB should call the insurance carrier. The carrier phone number should be listed on the EOB or on the reverse side of the Member ID Card. Consumers can also contact the NH Insurance Department Consumer Unit at (800) 852-3416, if they have additional questions."
This investigation was completed as a collaboration between the NH Attorney General's Office and the NH Insurance Department Fraud Unit.
New Hampshire Department of Justice | 33 Capitol Street | Concord, NH | 03301