ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Tuesday, July 9, 1996 TAG: 9607090088
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
SOURCE: JAN VERTEFEUILLE STAFF WRITER
AN AUDIT OF BILLING PRACTICES at Stewartsville's Wonder Drug showed irregularities, prosecutors say. But defense attorneys say Trigon's auditor is exaggerating.
After entering into a payment contract in 1991 with a health insurer they believed was unfair to independent pharmacists, Joseph and Beatrice Chopski put up a sign in front of their Wonder Drug store.
It read: "We take Blue Cross, but it sucks."
Blue Cross, now known as Trigon Blue Cross Blue Shield, didn't take kindly to the protest. An official phoned Beatrice Chopski and demanded she remove the sign in front of the Stewartsville drugstore. That official now works for a pharmacy auditing service that was at the center of testimony in U.S. District Court in Roanoke on Monday.
Joseph Chopski and the corporation the couple owns are on trial, charged with 21 counts of mail and wire fraud from January 1991 through July 1993. The trial could last two to three weeks.
The government accuses Chopski of padding bills to Trigon and Medicaid for prescriptions that never were filled. He also is charged with fraudulently billing Medicaid - even after his pharmacy had been searched by the FBI - for a patient whose bill already had been paid by Trigon. Beatrice Chopski, like her husband a pharmacist, was not charged.
The case is part of an effort by the Justice Department and the Western Virginia U.S. Attorney's Office to make health care fraud a priority.
But Chopski's prosecution involves questionable billings of less than $2,000, said his attorneys, who suggested that the FBI took the case because of exaggerated claims by Trigon's auditor that there were hundreds of thousands of dollars in fraud involved.
There was time for only one witness after the jury was seated Monday. John Tripodi, who owns Heritage Information Systems, audits pharmacy billings for Trigon and other insurers. His company looks at computerized bills submitted for patients who have prescription plans that have a third-party payer such as Trigon pick up the tab, with the patient making a $5 or $10 co-payment.
In Chopski's indictment, the 93 billings alleged to be fraudulent were billed for patients who have such prescription cards. In many of the cases, refills - not original prescriptions - were involved, because the paper trail is easier to fake, Assistant U.S. Attorney Karen Peters said.
When Tripodi began his audit, he mailed questionnaires to Wonder Drug customers, several of whom said they had never received refills for which Trigon had been billed. Tripodi then visited Joseph Chopski at the pharmacy, where, he testified, the druggist told him he padded the bills "because Blue Cross owes me money for claims they never paid me for."
He testified that Chopski told him he would consider repaying Trigon if the insurer kept his contract and didn't tell other insurers about the audit.
Chopski's attorneys sought to undermine Tripodi's credibility as an objective auditor by pointing to the volume of business he has done for Trigon - $1.8 million over four years. And Tripodi later hired the Blue Cross official who called Beatrice Chopski about the sign.
Tony Anderson, one of Chopski's attorneys, painted a picture of an independent pharmacist struggling to maintain the drugstore he helped build from the ground up.
"Why would he for $1,900 risk what he had built up, from [digging] the sewer lines and foundation?" Anderson asked. He characterized the discrepancies as mistakes made while using a complex on-line billing system.
But he also acknowledged that Chopski was angry at being pressured into accepting a payment system from Trigon in 1991 that cut his profits by 11 percent and paid a flat dispensing fee. The sign was erected in response to Trigon's "cramdown" of the payment system, Anderson said.
Assisting Peters with the prosecution is Bob Harris, an assistant state attorney general who serves in the Medicaid fraud unit. Harris' boss, Attorney General Jim Gilmore, has been a vocal critic of Trigon, repeatedly blasting the insurance company for deceptive billing practices that allowed the company to pocket secret discounts from hospitals without telling consumers.
Trigon eventually paid $28 million in fines and refunds to customers and was sued last year by the cities of Lynchburg and Charlottesville as well as Colonial Williamsburg. All three provided Trigon coverage to employees and wanted the discounts refunded.
Of the 40-member jury pool called Monday - half of whom are insured by Trigon - no one said he remembered any news coverage about those problems.
LENGTH: Medium: 82 linesby CNB