Thomas E. Hoshour D.O./Sober Life Alternatives
Anthem Blue Cross Blue Shield
The scope of this investigation was well-coordinated across multiple parties and resulted in convictions on both state and federal charges. The case generated significant publicity around the issue of healthcare fraud, fuelled by the breadth of investigative techniques used, and also by a perpetrator with a flair for the dramatic.
Program Elements
- In 2001, the Anthem SIU received a tip that a Dr. Thomas Hoshour was upcoding office visits for substance abuse treatment. When questioned, Dr. Hoshour claimed that his one-year alcohol and substance detoxification program was unlike any other program in the state of Indiana.
- Further separating his clinics from a typical practice, Dr. Hoshour claimed to treat over 600 patients personally. Suspicions were heightened the following year when another insurer contacted the Anthem SIU: both insurers now believed that Dr. Hoshour was fraudulently billing them.
- Anthem and the second insurance company began a joint investigation in early 2003. Indianapolis police made 2 undercover visits to Sober Life Alternative clinics utilizing Anthem BCBS member cards. Fraudulent claims were consequently submitted to Anthem by Dr. Hoshour's practice in relation to both visits.
- From April 2003-June 2003, a total of 14 undercover visits were made by Indianapolis police detectives. In an initial visit, Dr. Hoshour met with an undercover detective for a total of 9 minutes. Claims submitted to Anthem revealed that Dr. Hoshour billed for a 60-minute office visit, a drug screen, a comprehensive metabolic panel and complete blood count, none of which were performed. During the subsequent 10 visits, the detective never again saw Dr. Hoshour personally, yet Anthem was billed for a high level office visit, each time.
Program Results
- In July 2003, search warrants were executed on all of the Sober Life Alternative clinics and Dr. Hoshour's medical license was suspended . In November of 2003, Dr. Hoshour did not appear for a court date and faked his suicide before fleeing the state. In early 2004, he was discovered in the home of former employee and was taken into custody.
- Dr. Hoshour was sentenced to 6 years in prison with a 50 year suspension of his Indiana medical license. Shortly thereafter, Dr Hoshour faced federal charges for defrauding Indiana Medicaid and was sentenced to 14 months in federal prison.
Contact
Cynthia Lucas, Senior Manager, 317-287-5540, Cynthia.lucas@anthem.com
