Medical Fraud Investigator Angel Celucci visits Fraud Busting. She says 90% of the medical bills we get contain fraud and has a proprietary system on how to spot it so you keep your money in your wallet. She’ll give us the update on ID theft around the COVID vaccine, pharmacy fraud and also tell us about how she fell for a scam herself but managed to get all of her money back.
Here’s the transcript:
Traci Brown: Angel, thank you so much for coming on Fraud Busting! You are just a fireball of energy from what I can tell. I can’t wait to jump into some of what you’re doing. Now, you are a family nurse practitioner turned medical fraud investigator. Tell me, what do you do all day?
Angel Celucci: Now, actually I teach people how to do what I did. I have been in healthcare, I say I’ve been in healthcare my whole life since I was 13. I started out as a candy striper.
Traci Brown: Oh yea!
Angel Celucci: I’m careful. I don’t say candy stripper. That was in my 20s.
Traci Brown: Careful about that. (Laughing).
Angel Celucci: I am! Then became a nurse. Nursing is just in my core, and then I became a nurse practitioner. But then when I moved here to the Nashville five years ago, I was introduced to a woman, another nurse, who was investigating for fraud. I’m like, “Our healthcare industry has fraud? What are you talking about?” That was foreign to me. I had no idea. So she started showing me what she did, and I’m like, “Okay, I need to do that.” So I did that for about five years now, and then I realized when I was looking at my numbers that what we are finding, we found, looking at just our data, 9 out of 10 of the bills we reviewed contained errors and are blatant fraud. So then a switch went off and I’m like: Wait a minute. People don’t know this stuff. We’re working for the insurance carriers, who are in bed with the hospitals, and yet, they’re paying people like me to check on them. I’m like, who’s helping the consumers? Who’s helping the people who are paying the bills or the uninsured people? So now I transitioned into investigating in the medical fraud and now I want to teach people how to do what I do. That’s kind of my transition, so now I’m more on – we still investigate for fraud, but my goal right now is to more so teach every single person I know how to protect themselves from fraud.
Traci Brown: Oh, wow! Okay. So are you, just to clarify, are you training people to do your job, like career path stuff, or just regular people who happen to have a hospital bill that they need to pay. Like what side are you on or are you doing both?
Angel Celucci: Nope. I just want to teach, like you. I want to teach your friends. I want to teach your parents. I want to teach anybody, I say nonelderly, primarily uninsured people or people with high deductibles, underinsured. I say nonelderly because once you hit 65, people are typically on Medicare and they tend to not be as concerned with their medical bills. But no, I want to help my kids who are in their 30s. I want to help my neighbors. I want to help people. Now, if somebody wants to be trained to do what I do so that they can then teach more people, sure. But my whole goal is to put the healthcare system back in the hands of the people.
Traci Brown: Ahh!
Angel Celucci: Not those corporate CEOs, lobbyists. One of my favorite quotes is “Power should never be in the hands of so few and powerlessness in the hands of so many.”
Traci Brown: Right. Yea.
Angel Celucci: Kind of switch that and make people more educated and more empowered consumers of healthcare. I keep saying consumer, Traci, because to me, even the word patient is disempowering.
Traci Brown: Okay.
Angel Celucci: You know, patient is passive. I want people to realize, you’re the CEO of your body. Let’s own it. We barter for everything else in our life, and we know the prices on everything else, and we’re allowed to question everybody else, whether it’s at the grocery store or the car dealership, anybody, we’re allowed to question, but we’re not allowed to question the healthcare system. And nothing is more important than our bodies.
Traci Brown: You can’t even get a price on anything. How on earth is this legal even? Like what’s your take on that?
Angel Celucci: Well, I was going to say, it’s not legal. From what we know of legal and not legal, we would say it’s not legal. But there are no regulations. Nobody regulates what the hospitals can charge. Here’s the thing, I don’t have a beef with providers. I’m a provider. Providers don’t even know. When you go to your doctor’s office and you say, “How much is this going to cost me?”, they really don’t know. They don’t know until they put it in their system, and it’s based on your insurance and all of that kind of stuff. My beef is with the hospital administrators, the CEOs, the lobbyists, all those people who have what’s called a charge master. Are you familiar with the charge master?
Traci Brown: I am not. Fill me in.
Angel Celucci: A charge master, every hospital has their own charge master. That’s what their prices are for that hospital. For example, like a Starbucks on every corner, if you are in an area and there is a hospital on each corner, hospital A could charge you $10,000 for a shoulder x-ray, hospital B could charge you $1,000, hospital C could charge you $500. Nobody regulates what hospitals charge. Their employees don’t even have access to the charge master. A friend of mine worked in the coding department of a major hospital, and he didn’t even have access to the charge master.
Traci Brown: Huh.
Angel Celucci: Only the people with the finances, the billing and the CEOs, those people.
Traci Brown: Okay. So we’ve got a big mystery on our hands anytime we go to the doctor, anytime we go to the hospitals. I’ve been in the hospital a couple of times with different injuries and things like that. Then you get a bill back that is a bunch of gibberish. I remember looking, and it’s been years, but $20 for an aspirin, like that kind of thing. How do you interpret all this stuff? How do you know what’s fraud, what’s a mistake, what’s even reasonable? Where do you start?
Angel Celucci: The first thing I teach people, I’ve created a proprietary system. I call it the DOVE System. It stands for Document, Organize, Verify, and Engage. You don’t need to do anything. You don’t need to buy anything. It’s just a mindset. By incorporating this system, you will have financial peace of mind, keeping your money where it belongs, in your pocket, and also knowing that you’re not getting billed for medically unnecessary treatment. So, to answer your question, if you go to the hospital, first thing, is if ever you are admitted into the hospital – was that a sign for me?
Traci Brown: Oh, no. Sorry. I was trying to get my camera to focus. If I put my – because it went to de-focus. If I just kind of go like this, it’ll focus back on my face.
Angel Celucci: Oh, good. Mine does that all the time too, and I never knew how to fix it.
Traci Brown: Yea.
Angel Celucci: So, first off, you asked about the $20 aspirin. That goes back to the charge master. Hospitals charge whatever they want. That was what my friend asked at a conference. They asked the financial person: How come their hospital charges $100 for a Tylenol, and ours charges $30? Like how is that even rationale? They said, you don’t need to concern yourself with that. You just worry about the codes. Like they really keep their people in the dark. So, what I would do is I recommend people use what’s called – very, very basic – there is a website called HealthcareBlueBook.com. Now we use a national database, the same ones that the insurance carriers use, when we check prices for people. But what you’re looking at on – very basic, people can do, you just put in your zip code and then you put in the code that is on your bill, and it will tell you. Okay, this code, because you know they speak gibberish in numbers, this code means you had a shoulder x-ray. I always use that example. And for your geographic area, this is the going price for that. It will look within a 20-mile radius of where you are. Let’s say you are charged $50 for a Tylenol, but HealthcareBlueBook says well, the going rate is like $20 for your area, then I tell people to respectfully engage – that’s the E part – and negotiate with your hospital, with your provider. Say, “Hey, I was billed $50 for this, but the going rate in our area is $20. I’m willing to give you $30.” We can negotiate anything, and people don’t realize that. Then back to the document, the DOVE system, the other important thing is if ever you are admitted, and along the lines with the Tylenol, if ever you are admitted into the hospital for an extended period of time, and you know how the nurse will always come in like every 4 hours. Do you have pain? Your doctor ordered pain medicines for you. If you say, “No, I don’t have pain”, there’s a good chance it’s not getting documented. Then there’s a good chance that if you didn’t take any pain pills the whole time, the 3 days you were there, what’s that? Every 4 hours. So, 12 times. If you didn’t take Tylenol ever, you could still be charged for that. Unless you’re documenting what is actually occurring and then what is documented, that you had received the service, everything, and then verifying it, comparing it to when you get your bill, that’s how we can identify one of the most common types of billing fraud, and that is billing for services not delivered.
Traci Brown: Okay. That sounds good. That sounds great. Here’s my challenge. The times I’ve been in the hospital, I have been out of it. I mean, I’m knocked out because I used to be a professional bike racer and I’ve got to tell you, I hit the ground pretty hard a few times, concussions, knocked out my teeth, broken legs, like that kind of thing. There is no way I could have possibly been alert enough to write down what was happening to me. So, how do you get around that? Do you have to have someone there? That’s the only way I could think to do it. What’s your idea?
Angel Celucci: Well, yes. Honestly, Traci, I would have never thought this until recently a friend of mine who is a provider, he’s a chiropractor, and he spent 6 days in an ICU. He called me when he got out and he said, “Girlfriend, you need to let people know that if ever you are admitted in the hospital, if you don’t have somebody there documenting everything for you, you’re basically screwed.”
Traci Brown: Yea, you are. Yea.
Angel Celucci: Right. This is another provider saying this. Again, this is not an issue with providers. I want us to trust our providers. It is the system itself that we need to address. But if you don’t have anybody else with you and you’re the only one there, heck, I’ve been to the hospital and I haven’t had anybody there, but then I am very, very intensely looking at every single item. I am requesting an itemized bill. For example, I can’t think of something right now that you would be a red flag for you, but like if you saw on your itemized bill you were billed for this, and you were like, wait a minute, did I get that? If you don’t remember, you can always call and you can say, “Hey, I was billed for this on this date. Can you please check the record? I don’t recall receiving that.” Like, we can question anything. But if you don’t have somebody with you, then you want to get an itemized bill and you want to read line by line what you’re being charged for. If it seems reasonable, like, yea, I probably did get that, then I would go to HealthcareBlueBook.com and see, does that price now seem reasonable for your area?
Traci Brown: Yea, yea. I mean, you’d have to have someone there. There would be no way. I’ve got an itemized bill before, and I’ll tell you why I got an itemized bill, because I got hit by a car when I was riding my bike and broke my leg, and ended up having a pin put in my leg. At that point, when you have a pin in your leg, you’re doing pretty good. You can ride a bike. I wanted to get back to racing because that’s what I did. I went to a big national event. I wasn’t full speed, but I was good enough to get there. They had drug testing there. I was like, I do not know what on earth they have put in me. I brought the hospital paper with me and I gave it to the drug people. I’m like, this is what I’ve been on. Here you go. There was so much stuff on there that I had no concept of what any of it was or what they did or anything. Yea, that’s a huge challenge.
Angel Celucci: Very much so. You know, along the lines of the hospital administrators and doing this kind of stuff, you don’t know if it’s medically necessary. That’s a fact. We don’t know if it was medically necessary or not. There was a situation in Florida. There is a hospital system in Florida that has to pay $260 million in penalties because the administration aggressively pressured their emergency room physicians to admit anybody over the age of 65 whether or not it was medically necessary.
Traci Brown: Huh. That is interesting. Okay. Okay. So they’re paying. Are the patients getting their money back?
Angel Celucci: That I don’t know. It’s not them. It’s the Medicare system. Remember, over 65, they’re on Medicare.
Traci Brown: Oh!
Angel Celucci: Who pays for Medicare, Traci? We do!
Traci Brown: We do!
Angel Celucci: Exactly! This was a crime against us, the taxpayers. People are like, I don’t care about medical fraud. I’m like, but you should if they’re going after Medicare because that’s going after you and I! How this came about, how this came to light was that . . . for example, if you took an elderly friend with you to the ER for just a cold, there’s a chance they could have gotten admitted. This one physician, he overrode the system and said no. He went to discharge them, and the system popped up and said: Are you sure you want to discharge this patient? He overrode it. Yes, I do. So, then it came back again. This patient is over 65. You may be missing something. We recommend you admitting them. He overrode it three times. The next day, administration came down and asked him: Why did you discharge that patient? They were over 65. You should have admitted them.
Traci Brown: Oh my!
Angel Celucci: Because Medicare is a blank check for hospitals. They were billing for unnecessary services. Now, just the penalty part is $260 million.
Traci Brown: Wow. On that note, let’s talk about COVID because there are a couple things I’m hearing going on. This happened to a client of mine’s friend, so I’m a little bit removed, right, a little bit removed from it. Her husband died of a heart attack, and she got the death certificate back and it said COVID on it, which he did not have. Are hospitals indeed getting more money for a COVID death somehow than any other cause? Do you know anything about that?
Angel Celucci: Honestly, I do not know anything about that, like the statistics to be able to give you an honest answer. I’ve heard those things as well, but then I also can’t help but think, how do we know he didn’t have COVID? Did he test negative at the time of death?
Traci Brown: I believe tested negative when they brought him to the hospital. So, could he have contracted it in the hospital? However, she is very . . . I don’t know about the numbers. I’m not saying we don’t have a problem. We do have a problem. I don’t believe the actual numbers. That’s where I am on that. I am going to task you to find out because this is your Fraud Busting challenge.
Angel Celucci: Should I choose to accept it?
Traci Brown: Yea, should you choose. Okay. Here’s what else I’m hearing with COVID. This is from a story in Dallas. People are doing identity theft so that they can get their shot earlier.
Angel Celucci: Yes!
Traci Brown: What do you know about that?
Angel Celucci: That is one of the fraud schemes actually I wrote down to tell you about.
Traci Brown: Yea. Let’s talk about it.
Angel Celucci: What you want to teach people, what I want everybody to know is unless you initiate the call, don’t give out your information to anybody. If you are getting an unsolicited phone call, an unsolicited email, an unsolicited social media post, and they are saying that, oh, you can get your name on the list for a COVID vaccine, or oh, we can set you up for faster testing than anybody else, all this kind of stuff, as soon as you hear that, I tell people, I know it’s rude, but just hang up on them because it’s a fraud scheme. Your doctor is not going to call you and say, hey, I can put you on the list. He may say that, but then he will say – he’s not going to ask you for your credit card. As soon as somebody says, would you like to be moved to the head of the list? Oh, we have this special dispensary. We’re able to get COVID vaccines for you. All you have to do is give us your credit card number or all you have to do is give us your Medicare number – click. Hang up on them. Anytime an unsolicited call asks you for your insurance number or a credit card number – click. Hang up.
Traci Brown: Got it.
Angel Celucci: Marketers. Those are scams. Now, you will get emails, unsolicited emails from your provider. I have gotten two from my hospitals and my providers.
Traci Brown: I’ve gotten several. Yea.
Angel Celucci: Just an update. Right. They are not asking for my insurance information or my credit card information. Anytime anybody calls or an unsolicited phone call, email, text, Traci, I fell for a scam.
Traci Brown: You did? Wait, what happened? How?
Angel Celucci: I was out $3,000. Yea, not medical. It was – I’ve gotten it all back – hours on the phone. But what happened was I got this text and it was from Whole Foods, not the real Whole Foods. You always have to check the email or the address to see where it was generated from. So anyway, it said we are hiring secret shoppers in your area to go and give an evaluation of the stores in your areas, blah, blah, blah. They were courting over a period of like three months. Would you be interested? Not for nothing, but the longer COVID goes on, we’re all looking for some extra money to make, right?
Traci Brown: Yea, yea, yea.
Angel Celucci: So, I’m like, yea, I’ll do it. They were going to pay me I think $250. Great. So, I get this package in the mail and my instructions. My instructions were: I received a check for – I forget how much – I want to say $2,500. I had to deposit the check. Then I had to go to CVS and Walgreens and I had to buy Nike gift cards.
Traci Brown: Oh yea.
Angel Celucci: You’ve heard about that scam?
Traci Brown: It rings very familiar, not necessarily the secret shopper, Whole Foods part, but it’s stacking up along the lines of things that happen. Keep going, keep going.
Angel Celucci: I wish I would have know you because as soon as I started telling my kids about this, as soon as I got to that point, they’re like, please tell me you know it was a scam. I’m like no! I didn’t! So, before I went to the store to buy the cards, you had to deposit the check. Well, I used my phone, so I go to do the direct deposit and my bank said, it was Bank of America, it says your ID isn’t working. So, I tried it again. It says, your ID is incorrect. I’m like, it’s my phone. How can it be wrong? So I thought, forget it. I’m just going to go buy the cards with my money and then I’ll deposit it after. So I get to CVS, I buy the cards, I buy three $500 gift cards. Hold on. By the time I bought all the gift cards, I now get a phone call from Bank of America. They’re like, “Did you buy blah, blah, blah, Nike gift cards?” And I said, “Yes, I did.” They said, “Did you buy them for a friend or a family member? I said, “No. It’s this new job that I have. I’m a secret shopper, and I’m giving these rave reviews for my people that are in the stores that are working, my friends.” She’s like, “Oh, sweetheart, that’s the biggest scam going on right now.” I freak out. I’m like, “What do I do? What do I do?” She’s like, “Please tell me you did not deposit the check.” I’m like, “Oh, you know they sent me a check?” She’s like, “We know. Did you deposit the check?” I said, “No. My phone wasn’t working. I was going to call you guys.” She’s like – are you ready for this, Traci? If I would have deposited the check, I would have been found guilty of a felony. Bank fraud. Check fraud.
Traci Brown: Wait! How?! Wait!
Angel Celucci: Because it’s a fraudulent check. By the time it would have cleared in my bank account, the fraudsters will have already have had the gift cards because that’s what I had to do, go buy them and send them the numbers, which I didn’t even send them the numbers because Bank of America called, but they would have had the gift cards. They would have had the numbers on the back, the scratch off part, and then by the time the bank cleared the check, then they would know it was fraud, and I’m left now out that money, plus I would have been found guilty of check fraud.
Traci Brown: Oh, my goodness.
Angel Celucci: There are people, elderly couples, there’s a husband and wife, because once I started googling it, there was a husband and wife in Florida. They both got the job. They both cashed the check. Both of their credits are shot now. They can’t own a house. They’re out of the money that they put up and the check. Yea. And they’re found guilty of a felony.
Traci Brown: Wow. So, you got your money back though, most of it, right?
Angel Celucci: I spent 20 hours on the phone. Yes, because first of all, I didn’t send them the gift card numbers. That was my first thing, which was great. I was out my money, but then, I had no idea, CVS has a legal department. They have a fraud investigation department. They have those two departments also, and then I had to call the Federal Trade Commission. I had to file a police report. I did all of these things. It has taken me – all this happened in the end of September – October, November, December, and just last week I got the last check back, so four months to rectify this.
Traci Brown: Oh, my goodness. Wow.
Angel Celucci: There are organized crime rings doing this to people.
Traci Brown: Oh yea. Well, there’s whole office buildings over in Africa. This is what they do. It can be state supported or not. Actually, Tim McGuinness, he’s been another guest, and this is what he focuses on is human enabled cyber fraud, which is essentially what this is. I’m glad that your bank account got locked somehow. It sounds like someone was watching over you.
Angel Celucci: Uh-huh. Because it wasn’t a password. It was just my thumbprint.
Traci Brown: The thumbprints, they say, those are super risky because you’ve got one. That is it. Like passwords, you can come up with a zillion passwords, right, but the thumbprint, you’ve got one. Someone gets a hold of that. You think you’ve got a problem now. You’ve really got a problem if someone gets a hold of your thumb print, right. Alright, what other kinds of fraud are you seeing out there? Let’s go back to medical fraud. What are you hearing about it? What’s the biggest case you’ve worked on? Let’s talk about that.
Angel Celucci: So, I personally haven’t had any big cases that are exciting and juicy. We have reviewed medical bills where our client, the insurance company, was charged like $150,000 and then we review the charges. We review all of the medical records also to make sure they’re coding properly and that the treatment is reflected in the codes and all that. The one, they were billed $150,000, and we said, nope. All of it was fraud. We reduced that. So we saved that client $150,000.
Traci Brown: Now, that sounds like a pretty big case. I think you’re kind of like, oh, it wasn’t that big. It sounds big to me. What are your red flags? How did you know? Let’s jump into that. You may be restricted a little bit on what you can say, so don’t say anything like illegal or anything. How did you get to that final result?
Angel Celucci: I’m not restricted in any way. To me, it just sounds boring.
Traci Brown: Not boring! This is what we do on Fraud Busting! (Laughing).
Angel Celucci: Okay! One of the things is we look to make sure . . . we see a code. For example, ENM codes, which dictate how much time and evaluation management, how much time in certain things that the provider did to be able to bill a certain level. There are really only five levels, like 1, 2, 3, 4, 5 , so 1 is like if you went to your doctor to remove a wart and 5 is they’re cracking your chest open and they’re massaging your heart kind of thing.
Traci Brown: Yea, yea.
Angel Celucci: So, there are certain professions that are not allowed to charge a 5. So, if we’re reviewing medical records and it is treatment provided by a chiropractor, why would a chiropractor ever bill a 5? They can’t. They’re not allowed to legally. Then we adjust the prices based on that. Or we also look to see whatever they’re billing and coding, did the patient actually receive it? Did it match the symptoms? If we’re looking at an ambulance bill because we’re looking at it from ambulance all the way through to discharge. If the ambulance bill . . . if we know and we’re reading the record, and we can tell who is on the ambulance, whether it’s a paramedic or an EMT. Let’s say there’s just an EMT on it. There is not a paramedic, which means it’s a basic, like they are charging for a higher-level acuity, that is upcoding, so we negate that. We’re like, that’s fraud because it wasn’t an ACLS transport. It was a basic BLS transport. We look at things like that. Then the biggest thing that we actually laugh at and get a kick over is if we see the same medical records, the patient is seen three times a week, let’s say in PT, physical therapy, or chiropractic, we can actually take the notes and we can take three pages, or four pages and hold them up like this, and they’re verbatim, verbatim. The vital signs are the same. The time stamps are the same. Everything is identical. Then we look further into it. We’re like, okay, did they actually receive these treatments? Especially with the electronic health record, they’re just generating these without actually doing the treatments.
Traci Brown: Right.
Angel Celucci: So generating these without actually doing the treatments, so we make sure that the treatment reflects what they are coding for. Another thing we look for is double billing. We look to see, are you billing them two times on the same day for the same procedure? That’s double billing. That’s a form of fraud. We look for unbundling. Unbundling, the example I give is if you went and got a happy meal, a bargain meal. What do they call those? Bargain meals, right?
Traci Brown: Oh yea, yea, like a #3 at McDonalds.
Angel Celucci: Right. Exactly. If you said I’ll have a #3 at McDonalds, and they’re like, “Well, that will be $72” and you’re like, “What?!” They’re charging you for the cup, the straw, the lid, the ice, the bun, the one pickle that you get. There are certain procedures within the healthcare system, procedures, supplies, and services that should be billed as one because they’re always given at the same time. For example, there is a lab study called a chem7. There are 7 different tests in that. As we reviewing the bills, if we see they’re parsing out every single one of these, that’s considered unbundling, that’s fraud, and we negate that as well.
Traci Brown: Huh. Wow.
Angel Celucci: We can identify unnecessary treatment too, like if the patient’s complaint is – I don’t know – something simple, and they’re doing something extreme, that is a medically unnecessary treatment. Now, for things like that, like I’m a nurse practitioner, and I only hire nurse practitioners, but if there is an issue where we feel that a providing is giving medically unnecessary treatment, whether it’s an orthopedic surgeon or a pain management MD, we then send the records to a like-minded peer. So, we will send it to an orthopedic surgeon or a pain management doc so that we get a peer review because then we can say, okay, based on your medical training and theirs, was this medically necessary? A lot of times they come back and say, “No. It’s not medically necessary.”
Traci Brown: Wow. Okay. Then, can individuals hire you. Are you mostly just working with insurance companies? I don’t want to go to a hospital, but the next time I do, whenever that is, hopefully it’s a long time, but should I just be sending the bill out to you for review? How does all this come together?
Angel Celucci: So ideally, I want to teach people. I have two things. I have a do-it-yourself and a do-it-for-you or a do-it-with you. The do-it-yourself, I want to teach people how to do this themselves because I can’t be there with you in the emergency room when your doctor says, “I need to have this done” or “You need to have this done”, “You need to have this test done.” I want to teach people how to say, “Okay. Why do I need to have that done? How is that going to change my treatment plan?” I want to teach them how to be a more educated and empowered patient. Then also, when your bills come in, I don’t want you to have to call me every single time. I want you to have the power yourself to know, “Alright, Angel said to do this, this, and this. I’m doing this, this, and this. Oh my gosh, look, I just found it and now I know what to do to negotiate it. Yay me!” But if you’re looking at it and you’re like, “Oh crap! I don’t know what to do with this”, then you say, “Hey Angel, what do you have for me?” Then we have services. Our services for that are we would review all of your medical bills. We give you a nice customized report where we say, look, this is the code. This is what the code represents. This is what you were billed, and based on your geographic area, because we use a national database that we subscribe to, based on your geographic area this is considered usual and customary. It’s called the usual and customary fee for your geographic area. Now, two things can happen there. If we say, “Look you were billed $50,000 and only $2,000 of it is legit”, we then give you the templates for you to use to negotiate with your providers.
Traci Brown: Oh!
Angel Celucci: Or to negotiate with the hospital.
Traci Brown: That sounds fantastic!
Angel Celucci: Yes. All of it. Now, the bad thing that can happen is . . . we just reviewed records for a gentleman, just his medical bills, and he was billed $51,000. His portion of that was $10,000 after his insurance, but when we looked at it all the fees were legit and reasonable for his area except for maybe like $1,000. So, I said to him, “The good new is that you are with a facility that is billing fairly.” You have that confidence know that because ideally that’s what we like. In my head, I know we say that you’re innocent until proven guilty. To me, you’re guilty until proven innocent, so now you’re proving that your hospital provider is billing appropriately. That gives you a sense of peace of mind and confidence. If you find that they’re not, then you need to do something about it.
Traci Brown: Sure. Sure.
Angel Celucci: Case in point, I had some procedures done at Vanderbilt University here in Nashville, and boy, I was scrutinizing those bills every single time. Every single time, I’m like, “Dang gone it. They’re really good.”
Traci Brown: They are. You know what, I know the head medical auditor over there because I ended up working with the Medical Auditing Association of Hospital Auditors, I think. Anyway, loved them, love Vanderbilt.
Angel Celucci: Yea. They’re very good. Can I also share one more thing, another type of fraud? Because there are so many different types of fraud up in the medical system and anybody within the medical system, from a home healthcare agency, ambulance, chiropractors, providers, hospital, anybody could commit it, pharmacy fraud. I want your audience, your listeners to know also that there is such a thing called pharmacy fraud. There are several different variations, but the one is if you receive pills, not liquid, but actual pills, loose pills, you always want to count them when you come home, especially when you are getting 90-day supplies sometimes if you are going to one of the local pharmacies and you are getting 90-day supplies because a lot of times what they’re doing is they’re shortchanging you by a few, which is keeping it in their inventory, but they’re still billing you or your insurance carrier for pills. It happened to me two times in a row. I was getting prescriptions, a 90-day supply, and I come home and I count them. The first time, instead of 90, I got 80, and then the second time I had gotten, I think 82. It’s always an even number. So respectfully, I teach people, just be respectful because people want to help people that they like. Right.
Traci Brown: Oh, yea, yea. Totally.
Angel Celucci: So, I went back to them. I said, “Guys, I know you’re so busy, but I’m missing 10 pills. Could you please give them to me?” They counted them, and they were like, “Oh my gosh, we’re so sorry, blah, blah, blah.” Second time it happened I’m like, “Guys, this is the second time. I know you’re really, really busy, but I’m counting my pills.” And they’re so overaccommodating. Now that tells them two things. Oh shit, she’s checking her pills. We better make sure we’re on top of it. Or, they have an internal issue that somebody can’t count. Then the other thing, if you have prescription insurance, make sure that your medications when you’re looking at your EOB when it comes in, your Explanation of Benefits, make sure that if you don’t have a medication on auto refill but you see you’re getting it every month, that’s a form of pharmacy fraud. They’re putting your prescription on auto refill so that they can bill your carrier even though they’re not providing it to you every month.
Traci Brown: Oh, interesting. Your coverage could not cover auto refills?
Angel Celucci: No. It would cover it, so your carrier is going to keep paying it, thinking you’re getting it, but you’re not getting it.
Traci Brown: Oh.
Angel Celucci: So, billing for services not delivered. That’s another thing. My whole message with everybody is that I don’t want you to be fearful. I don’t want you to be have stranger danger. I want you to have a healthy version of what we teach children of stranger danger. Just be educated. I tell people, just step into your power. You have more power than you realize, but they don’t want us to know that.
Traci Brown: I guess not. Huh. Okay, so much does it cost? Let’s say someone goes to the hospital and they get a big bill. They are not liking the looks of it, and they send it to you for review. What do you charge? How does all this work?
Angel Celucci: Well, that’s a good question.
Traci Brown: Don’t be like the hospitals and don’t tell me! (Laughing).
Angel Celucci: That’s where I come from. I want to have full transparency. Look, I want to be able to pay my bills. I’m not looking to build a dynasty here, but there are a lot of companies who do bill negotiations or billing advocates and take 30% of whatever they save you.
Traci Brown: Okay. Okay.
Angel Celucci: If they save you $100,000, their bill is going to be $30,000. Well, my target audience is the working-class America. We don’t have that kind of money, in my opinion. So, what I have decided is I’m going to charge an hourly rate and it’s going to be based on your records because, Traci, what if you send me two bills and it takes me less than an hour to do, but then your neighbor sends me 200 bills and it takes me four hours to do, that’s more intensive. I’m just right now feeling out how the market is with just billing per hour for our services, and that’s it.
Traci Brown: Oh, wow. Okay. Okay. If someone saved you $100,000, but then you’ve still got to pay them $30,000, there is still a huge expense there, right, with these other companies. I mean, it’s not free.
Angel Celucci: They say it comes out of what they saved you. If they saved you $100,000, basically they saved you $70,000 because they’re taking $30,000. You know what I mean? So, you’re really out $70,000 because you’re still paying their portion. Do you know what I mean?
Traci Brown: Sure, sure. Yea.
Angel Celucci: To be honest with you, that’s too hard to figure out also. I like clean, dry, transparent. We’re charging the same thing we were charging our insurance carrier clients, and no, we are not working with insurance carriers anymore. We do have one that . . . we’ve been with them for over 20 years, so we’re still helping them with theirs, but our whole focus now is just teaching and empowering consumers how to do this themselves, and then also supporting them if they need us to do it for them. I get it. Sometimes it’s just overwhelming and you just want to say, “Please, do this for me” and we do that.
Traci Brown: I will be in that category for sure, the latter. Okay. You’re doing a lot of keynotes, speaking out there, it sounds like. What kinds of groups are you speaking to?
Angel Celucci: I like the 1099s. Anybody that is uninsured, so that’s all your 1099 people who are self-employed, like your laborers, your beauticians, anybody who does not have health insurance, those are my key target people. A lot of people in the FIRE nation now, I guess there’s a whole movement called FIRE, the FIRE movement, which stands for Financially Independent Retire Early. It’s very financially conscientious people, type of thing.
Traci Brown: Wow. Okay. Okay. Got it. How can people get a hold of you?
Angel Celucci: They can head over to my website, which is over https://overbrookconsultants.com/.
Traci Brown: Got it. Alright, alright, cool.
Angel Celucci: Thanks! Thank you. Thank you. Let me just see, is there anything else I want your people to know? Ask lots of questions. Keep detailed records. Always, always, always read your medical bills because 9 out of 10 of the medical bills you get in the mail could contain errors.
Traci Brown: Sounds like it. Oh my gosh.
Angel Celucci: This system, Traci, was designed to serve us, not to bankrupt us. It’s about darn time we let them know that, that we are watching, we are aware, and we want to keep our money where it belongs, in our pockets.
Traci Brown: Oh, I love it. You’re the best!