Te health insurance dilemma has been cleared up for me.

For the past few months, I've been investigating a surgery center whom I have reason to believe is billing large insurance companies in a fraudulent manner.

For the past 5 or 6 months, I've gone through thousands of pages of board of directors and governing committee meeting minutes, financial reports, audits, etc., etc.

So, last Friday, I was on a conference call with the top guy at one of the largest health insurance companies on he planet and two of his directors.

The conversation went something like this: "Mr. Colbert, we really appreciate all you've done and thank you for making this information available to us. We'll use it to conduct our own investigation and hopefully we'll be able to track down the wrong-doers and notify law enforcement and the regulators."

"That's great, Sir," I said. "I'm looking forward to working with you on this and am confident we can get to the bottom of this very quickly. In the meantime, I just have a couple of questions for you, would that be alright?"

"Sure," he said. "As long as I can answer them without violating, you know HIPAA regulations and such."

"That''s fine," I said, "I understand."

I continued, "Tell me a little about your company's system of checks and balances. If I go back a few years and find where the double and triple billing irregularities began, we can reference that to the new Biller and/or Hospital Administrator and hopefully come up with some questions for them.

"Checks and balances?" He asked.

"Yes," I responded, "tell me about your company's checks and balances system."

"We don't really have one," he answered. The system is based, you know, on good faith - an honor system."

Silence.....

"Okay," I said, "let me get this straight - I want to make sure I understand something. If a surgery center sends your company a bill for one million dollars, nobody is responsible for at least giving the bill a second look? You just write the check and stick it in the mail?"

"What if you knew the Biller at this particular surgery center was currently being investigated by the FBI for Medi-cal fraud and is at least partially responsible for the closing of at least four other surgery centers?"

"Mr. Colbert, we are very busy and have neither the time nor manpower to investigate every single claim - even if it is for $1 Million. That's why I'm happy we have people like you out there who'll bring things like this to our attention."

"Thank you," I said. "So I take it your checks and balances system is more reactive than proactive?"

"Exactly," he said.