Dozens arrested in Medicare fraud busts across US

[Purveyor]

Source: Associated Press

(07-29) 09:18 PDT MIAMI (AP) --

Federal authorities arrested 32 people, including doctors, in a major Medicare fraud bust Wednesday in New York, Louisiana, Boston and Houston, targeting scams such as "arthritis kits" — expensive braces that many patients never used.

It's the third major sweep since Attorney General Eric Holder, Health and Human Services Secretary Kathleen Sebelius announced in May they were adding millions of dollars and dozens of agents to combat a problem that costs the U.S. billions each year.

Using about a dozen agents in targeted cities, including Miami, the Medicare Fraud Strike Force, has recovered $371 million in false Medicare claims and charged 145 people across the country in just two months.

More than 200 agents worked on Wednesday's $16 million bust that included 12 search warrants at health care businesses and homes across the Houston area.

Federal authorities say those businesses were giving patients "arthritis kits," which were nothing more than expensive orthotics that included knee and shoulder braces. Patients told authorities they were unnecessary and many never used them. But health care clinic owners billed between $3,000 to $4,000 for each kit.


Read more: http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2009/07/29/national/a090107D45.DTL

[global1]

1. These Types Of Scams Are Going On All Around The Country......

this should be a shot across the bow of all of these criminals to stop. They should all be put in jail. We have the ability to screen this out of the system. This is another reason our health care costs are skyrocketing out of control. Stop these scams and we'd have a great deal of savings to put back into 'real health care reform'.

[formercia]

3. It happens with private insurance as well.

Just a couple of weeks ago, I watched the tech at my dentist's office add services to my bill that weren't performed.

The difference is, the Insurance companies just pass the cost down to their clients.

[global1]

4. I'm Sorry - But If You Knew That This Was Going Down - You Should Have Called.......

them on this and put a stop to it. Not acknowledging to them that you know what they were trying to do - is just encouraging them to continue this practice. When we see our health care practitioners trying to take advantage of the system - we need to put a stop to that - because they and we by not stopping these practices are just contributing to the high and escalating costs. It just boosts the premiums up for all of us - you included.

[Downwinder]

8. Have you ever tried questioning anything on a Medicare bill?

Lots of luck.

[global1]

12. The Comment In The Post Was......

"I watched the tech at my dentist's office add services to my bill that weren't performed."

It didn't say that they discovered this after the fact - but said - they watched in real time as the tech added services that weren't performed.

They should have called the tech on that as soon as it was happening. Sorry - just my opinion.

[No Elephants]

28. Funny thing. I used to call. Several times, my insurer told me they could not question

the provider. So, if I wanted to fight the charge, I should contact the provider directly. Originally, this same insurer used to ask insureds to call the insurer if they disagreed with any charge.

All times I called, it was about the emergency room of the biggest, most respected hospital in my state. I knew I would get nowhere, so I gave up.

That may be part of the contract between the insurer and the hospital--we (the hospital) will let you get away with reimbursing us at only X% of what we charge. In return, you don't question our charges.

[BonnieJW]

2. Another reason

to pay health care providers for outcomes rather than procedures.

[Thothmes]

16. So, that means if you die, they dont owe anything?

[ingac70]

5. People defrauding Medicare should be executed. n/t

[dave29]

6. I have a similar case being looked at by the Texas Medical Board

mine was billed to private insurance (which passed cost down to me) but my fear was that the lab that billed $1806 for my urinalysis without providing any information as to why -- was doing the same for medicare patients.

[jus_the_facts]

7. I recently emailed the La. State Attorney General's office....

....in regard to an arrest about a woman who was an account manager for a health care company I'd also worked for in the past..they were accusing her of stealing money from them...I HAD to let them know how I was personally cheated out of overtime I'd worked...my supervisor had forged timesheets for hours I'd worked...since the hours exceeded the state regulations for hours worked in a day....my supervisor kept the money for herself...I never saw a dime of it. I quit when we were called in to take piss tests 8 months after I'd been hired....mainly becaue I don't think my bodily fluids are the state's business but also because of the gross negligence in the company's ability to follow the state's regulations in other circumstances...I told them this company should be investigated on many levels...especially since they were crooks and were now accusing an employee of being one. :(

[ima_sinnic]

15. I hope you will also type a snail-mailed letter

I just don't trust e-mail to get the serious attention it sometimes deserves.

[Downwinder]

9. Don't blame the patients. This is nothing new.

The timing is probably to discredit Single Payer.

[corpseratemedia]

10. +1

[JDPriestly]

11. No. I think the timing is to show that the government watches for fraud.

[Downwinder]

13. A cost plus system encourages fraud.

Medicare is based upon the insurance model, the more you spend the more you make.

[defendandprotect]

14. Corporate theft from medicare increases it's administrative costs from .03+% to 06+%% --!!!

And don't see that they're recovering this money from the corporations despite

the fines/penalties --

PLUS ... any company/corporation which has been prosecuted successfully shouldn't

be permitted to use the program without a permanent penalty on them ...

[cal04]

17. Dozens arrested in health care fraud scheme

Source: Associated Press

Doctors among those accused in scam to bilk Medicare through false claims
MIAMI - Federal authorities arrested 32 people, including doctors, in a major health care fraud bust Wednesday in New York, Louisiana, Boston and Houston, targeting scams such as "arthritis kits" — expensive braces that many patients never used.

It's the third major sweep since Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced in May they were adding millions of dollars and dozens of agents to combat a problem that costs the U.S. billions each year.

Using about a dozen agents in targeted cities, including Miami, the Medicare Fraud Strike Force, has recovered $371 million in false Medicare claims and charged 145 people across the country in just two months. Medicare is the federal health care program for the elderly.

More than 200 agents worked on Wednesday's $16 million bust that included 12 search warrants at health care businesses and homes across the Houston area.

Read more: http://www.msnbc.msn.com/id/32205408/ns/us_news-crime_and_courts/

[Phoebe Loosinhouse]

18. Good. nt

[ima_sinnic]

19. good! fine those greed-heads hugely and lock up their thieving asses

those are my tax dollars, which I don't begrudge anyone for health care, being stolen by already rich-pig doctors.

[izquierdista]

22. Yup, lock 'em up!

That will teach them to bill for ICD-9-CM Diagnosis 714.2 when it was ICD-9-CM Diagnosis 714.89! :spank:

[SCantiGOP]

20. Oh crap

when I saw the headline I thought there were going to be GOP congressmen getting arrested.

[customerserviceguy]

21. And they will try this crap

with any public option or single payer system as well. Those who think that universal healthcare will not involve detection schemes that frustrate the innocent, yet still miss the guilty are fooling themselves.

Not that this is not a reason to go to single-payer, we still need that. But there will always be a hassle, whether it's a private company pencil pushing nebbish, or a government bureaucrat pencil pushing nebbish.

[jwirr]

23. Of course, that goes for any area of life - *ss tried deregulation and it

has proved absolutely useless. Laws are to control those lessor instinct we have that would allow many to cheat wherever they can. I do not mind laws - what I do mind is thinking that somehow the private sector would be any less likely to defraud if they can.

[irislake]

24. Wow! Corrupt health care professionals!

What next? Rabbis?

[DallasNE]

25. Well, Guess What

When the Bush administration let it be know that they would not enforce regulation it was like a green light for fraud and abuse. Now those chickens are coming home to roost. And it should come as no surprise that we ended up with Abramoff, Madoff and the rest of the rip-off artists now being charged with thieving on an unimaginable scale.

[Thothmes]

26. Hate to break the news to you

but there was medicare fraud before the previous administration. Madoff has been in the fraud business for the last 20 years. Can you account for that.

[DallasNE]

27. Read My Post

I was talking about the increase in the scale of the fraud during the Bush administration. Next I suppose you will try to claim that there was no increase in the scale of fraud. Or you will mention small time William Jefferson. Of course you will have nothing to back your claim up.

[Red1]

29. The Costly Effects

of 8 years of a rightwinger president ignoring regulations,

how the hell can anyone ever convince a conservative that
their votes end up pillaging the country?

[dugaresa]

30. I worked in the medical industry for years, some of the most corrupt people I ever met

I work in an entirely different field now, but the years I worked in the medical industry were quite eye opening.

I am sure it is the same now, but its all about the money and contrary to the complaining a lot of people have gotten very rich.

The people I worked with provided medical services, they were arrogant, rude, and they were corrupt. The game was to try and figure out how to extract as much money out of what ever insurance carrier they could. Medicare, Medicaid, Blue Cross, etc.

Regulations put in place to try and control how items/services were billed were constantly fought.

They would visit congressmen to try and get these items repealed or get loop holes.

Technically every patient has a collection of diagnosis codes associated with their care, these diagnosis codes have a matrix of acceptable healthcare procedure codes. The problem is that some patients only need one procedure or one service, but what stops a company from taking every other patient and applying all the codes to them as long as you get a physician to write a script saying those services are necessary? When you have the same doctor as a co-owner in such a business, the floodgates are open.

15+ years ago I remember a service provider joking how the state of California (where he was located and where I was doing some consulting) would be bankrupted by the medicaid system because of the services they were paying for on behalf of undocumented workers. Now I am not against providing healthcare but I had a funny feeling that he knew that they were providing services for "imaginary" undocumented workers.

I also want to add that these very people who got rich bilking the government and insurance carriers out of money, the very actions that help cause our rates to go up and our taxes to be illegal taken are typically republicans who "hate big govt".