Federal prosecutors have charged 107 people, including doctors and nurses, in seven U.S. cities, accusing them of taking part in schemes to cheat the Medicare system out of $452 million through phony billing. Authorities are calling this the largest one-day takedown ever by the government’s Medicare fraud task force.
At a news conference Wednesday, Attorney General Eric Holder said they “underscore the Justice Department’s determination to move aggressively in bringing to justice those who would violate our laws and defraud the Medicare program for their personal gain.”
Read the original story at CNBC.com
The 107 health care professionals, also including social workers and owners of health care companies, charged Wednesday worked in Miami, Tampa, Chicago, Detroit, Houston, Los Angeles and Baton Rouge.
The arrests are the latest in a three-year crackdown on health care fraud, which is estimated to cost taxpayers between $80 and $160 billion per year. Authorities recovered a record $4.1 billion last year.
Government Announces Massive Crackdown on Medicare Fraud
The government has also suspended payments to the 52 provider organizations where the individuals worked. Health and Human Services Secretary Kathleen Sebelius said the operation, including the arrests and the cutoffs of payments, are part of an effort to preempt fraud instead of relying on what she called the old “pay and chase” model.
“Now, we’re analyzing patterns and trends and claims data, instead of just going claim by claim,” Sebelius said.
Still, court filings allege the defendants were able to carry out their schemes for years.
NY Judge Denies DSK Motion to Dismiss Maid's Civil Suit
In Baton Rouge, seven people who ran two community mental health centers are accused of submitting more than $225 million in false claims for mental health services in a scheme that began in 2005 and continued through October. This case alone is one of the biggest ever Medicare fraud cases.
Government officials say the defendants from Baton Rouge rounded up drug addicts, homeless people and the elderly and used them to submit false claims for treatment.
In Houston, owners of four private ambulance companies were accused of billing the system for non-existent or unnecessary runs.
In Miami, more than 50 professionals were charged with carrying out a $137 million scam involving mental health services and home health care.
5 Things You Should Know Before and After Investing
Other cases involved fraudulent billing for ambulance services, durable medical equipment, psychotherapy and prescription drugs.
Pete Williams, NBC News’ justice correspondent, contributed to this report. Follow Scott Cohn on Twitter.
More content from msnbc.com and NBC News:
- George Zimmerman's old Myspace page includes slurs against Mexicans
- Chicago pays $45 million in 3 years to settle complaints against cops
- Maryland court finds pit bulls are 'inherently dangerous'
- Video: Obama describes raid that killed bin Laden
- NJ mom arrested after allegedly taking daughter, 5, tanning


There you go. Don't just blindly cut services. Clean sh*t like this up.
Agreed -- we need to be more intelligent about how things are done, and to nail fraudulent practices.
That said, we do need "death panels." Obviously someone with Stage IV colon cancer does not need a hip replacement when they only have 6 months to live. Taking away the profit motive from basic healthcare services is key to a working health system. Especially since some of these unnecessary procedures reduce the quality of life, or shorten the lives of people receiving them.
This level of fraud is on-going inside of every massive government program. I wish we had major elections every quarter instead of every 2 years, then maybe things such as these raids would get done more often as a means to show that government is serious about detecting and prosecuting fraud, rather than waiting for sparse POTUS election years. Now, if we can only find out why the increase number of disability applications has literally doubled the pace of jobs creation in only the last 3 years ...
Absolutely-catch the sob's and confiscate everything they own right down to (and including) their skivvies. Then have them spend hard time on the Aleutian Islands as the Guest of Sarah Palin's state for the rest of their natural lives. Then make certain EVERYONE knows the fate that awaits them if they do the same thing!
STexan nothing would get done then.
Set an example. Give them the maximum prison time and let the other (would be thief's) that this will not be tolerated!
Set an example. Give them the maximum prison time and let the other (would be thief's) that this will not be tolerated!
They will probably just get slapped with a few million dollar fine and then maybe sent to prison for a few years.
Agree with Ruken. Now what cuts will there be to those that need care.
As a health care worker things are already cut to much for the elderly.
Geowil and how would that differ from the current situation..
I agree with you RUKEN.. an investigation was halted here in the state of florida.. when the man being investigated for 130m in fraud was elected gov.. the outgoing attorney general set the investigation aside.... I got a speeding ticket think I can get someone to make it go away
What this really points to is the lack of oversight by the government. Start a program, continually increase its budget, and let it go. That is all we get from our government. Remember both Barney Frank and Chris Dodd said Fannie and Freddie were both sound, less then two years before they began the mortgage crisis. Frank and Dodd were in charge of doing the oversight. There is no shortage of waste fraud and abuse in Washington, 450 million is a start, but it represents only a drop in the bucket.
Part of the problem with government run programs is the way they get funding increases. If they don't spend their entire budget, they are not likely to get an increase. So the incentive for programs is to spend, regardless of need. That is counter productive to looking for waste fraud or abuse since the incentive is to spend the money to be eligible for more. So no incentive for uncovering anything.
forget prison time... just execute them. Sets an example and saves money!
Amen!
The government needs to clean house just like this before they put their hands out to the public for one more dime!
These are just the ones they've caught so far. The potential for fraud is so great, and the likelihood of getting caught is so small it is no wonder that so many healthcare practitioners are getting their hands dirty at the public trough. The many loopholes and lack of systematic cross-checking which allow claims to be processed without any adequate safeguards to verify legitimacy are built into the legislation. It is simply human nature to take advantage of such lax oversight. However, there is a reluctance on the part of the legislators to plug these inadequate system checks because it might limit the flow of campaign funds.
This kind of stuff will never be stopped. Plug one hole, another is made. Gov't will always be vulnerable to the unscrupulous. Get rid of these vermin and others are waiting in line. Republican or Democratic led government won't matter. All the oversight legislation will do is slow down service delivery to the point that certain people who need it will die before receiving aid; which, of course, will become the next problem to complain about.
BTW Punish these people by making them hand-crank a wind turbine until their debt is paid.
Keep digging. That's only the tip of the iceberg.
Elections every three months?
How is anything going to get done with the politicians constantly on the road trying to get elected?
I for one don't want to see or hear smear, hate or otherwise inaccurate commercials every day. Policy would never be able to be shaped if our politicians are constantly on the campaign trail. If anything, the fraud would get even worse with our elected officials worried about having to campaign every other month.
The news would play out like this:
Senator Smith just won the election. Fast forward two weeks. Senator Smith is campaigning for re election.
While I share your same frustration, an election cycle every three months would just compound our problems.
This is why the govt SHOULD have oversight committees. Credit/Medicare/etc.
BTW, how does the govt know that the billing was for services not given? Did they talk to the patients?
Give the FBI Agents a 10% bonus incentive for every Medicare dollar of fraud caused by a scammer they apprehend.
The real problem is that they probably spent $500 million on the three year investigation to uncover this $450 million in fraud of which they will probably recover about one tenth of it. It is great to stop the fraudsters but the government needs to do it in a way that there is a net gain in dollars to the treasury. If they are spending more than they are getting back then they might as well just let the fraud go from an economic perspective.
Social security has tried to educate people about the bill they get. They are saked to read it and question what they don't understand and report any errors. They have programs set up to report to. The families of the elderly need to do this too. Read your statement. Question what you don't understand and report things you did not receive. People who sell or allow their numbers to be used should be cut off from services. They are trying to help us cut costs as much as possible.
This is just the "tip of the iceberg" (as mentioned above). GSA, DOE, DHS, and now this. ALL government agencies should be completely investigated for Fraud, Waste, and Abuse from the top down.
It is infuriating that we have "undisclosed" BILLIONS (probably) of Fraud, Waste, and Abuse within our government agencies while our "elite" and "above the laws they write" Congressional Representatives (Federal and STATE) continually try to find another way to further TAX the taxpayers.
One of my pet peeves is the 41 Obama White House staffers, and some of their aides, along with HUNDREDS of Congressional Representatives and HUNDREDS of government workers have FRAUDUENTLY FAILED TO PAY THEIR BACK IRS TAXES. And, the Secretary of the Treasury and the DOJ are doing nothing to take these fraudsters to Federal Court.
somebody said "don't cut stuff , clean stuff up"
I have said for years , clean up the fraud and waste and duplication AND prove it , and then I will talk about raising taxes
Sarcasticus1: I completely agree with your take on this issue.As an recipient of medicare and medicaid I am terrified of the socialist like way this country is leaning toward on this issue.The real truth is all the monies that for years would have been drawing interest should easily be self sustainable if not for spending our tax dollars on who knows what.But I am ashamed of our officials for using said monies without the permission of the people.These funds paid in to by each and every tax payer were never to be touched and it is infuriating to hear and see cuts being made to our seniors and disabled while using Billions annually in aid to our enemies abroad.
Ido: AMEN BROTHER.
If you look closely you will find that there is no one watching the hen house because they cut spending for policing the hen house and then we find out it is those RICH people who are frauding this gov't cause they have the ability and we little people do not.
Rich doctors and nurses. Just recently there was another in Texasssss that was about 450 million also.
Fraud is inevitable for ANY government funded service. However Fraud-detection is not sustainable.
Take money out of government administrations and you remove the problem. I have been screaming this for 30 years. All govt administered entitlement programs are doomed to be targets for fraud - period.
Social Security scams are also a nightmare. The money taken out of my paychecks over the years will probably not even exist when I retire.
I look forward to the day that the US begins to phase out entitlements.
This is just a small percentage who got caught...millions do it all the time..no wonder our health care cost so much. GREED at it again!
And the current administration wants to start a national healthcare ROFLMAO
tea1959, you realize much of this started under the previous administration and that ACA included the promise to crack down on fraud?
Also, surprised it took the national press this long to print this story. The ones in Baton Rouge (billings of $225M) were busted April 21st: http://theadvocate.com/home/2615683-125/feds-accuse-four-of-medicare
Suprise, SuprIse, SuprIse! Hope that prosecute and FINE them! And then give those Fines back to US!
Come on people. $452M split among 107 people is a measly $4.22MILLION each. In today's economy they would be lucky to survive.
Wow! Out of an estimated $80B to $160B per year loss that seems almost negligible - from 5% to about 2.5% recovery of estimated fraud. Given the government figures of $80-160B, I would really question that. When has our government been truthful and forthright about how inefficient it really is?
What do people think happens when public employees are pink slipped or departments downsized or oversight depts underfunded?
This sort of fraud happens because there are not enough people to provide oversight, do the utilization and review of billing for care whether it is in the hospital or the doctors etc offices.
Look at the states where these people were fraudulently obtaining payments for services not delivered or received? Some States already have utilization and review depts and do have contracts with private companies who also employ nurses and others to do these retrospective reviews of the medical records. If there is a pattern of questionable behaviour/charges etc are found then they do investigate. For profit health insurance companies do this sort of reviews also and they do have fraud units who investigate once 'oddities' or questionable charges etc are reported to them by these reviewers.
When the those T'repcondinos keep screaming about govt is too big and to do away with rules regs and oversight these are the things that happen as there is no one or not enough people to do the actual review of the services supposedly provided.
Wasn't the corporation that the now Gov of Florida was CEO of fined millions of dollars for this sort of fraudulent activity if I remember correctly? But as usual we keep doing the same thing over and over and expect a different result as we keep electing folks just because they may have run a corporation.
Why was there this need to have people receiving welfare or accessing the public safety nets to have drug testing? Drug testing cost money and is big business. Thus could it be that the drug testing is required so as to make money for some corporation or other that may have given donations to that polititian? One should always follow the money as it may be as the saying goes the old 'one hand wash the other' thing. LOL
Is it any wonder that some polititians have been underfunding the FBI amoung other depts/ agencies - eg consumer affairs- so that there is now not enough agents to do the investigations necessary? Wasn't it stated recently that the amounts of FBI agents -that are looking into the wall Street/bank debacle that tanked the economy in 2008- are way less that the amounts of agents that were assigned to the Savings and Loans debacle in the 1980s -1990s. The Saving and Loans debacle did not even tank the economy here at home much less globally.
Look at the FDA, the same thing is happening, ie. not enough scientists etc to do the reviews etc of drugs and devices and inspectors to inspect drug manufacturing plants, and inspect food producing/manufactoring plants and slaughter houses etc.
And the same for other depts and agencies. Wasn't NOAA, the EPA and other agencies like the one that inspects the nuclear energy plants etc underfunded recently? When this underfunding/cutting of funding or defunding these depts/agencies occur then we have issues/problems and deaths that are now showing up even more so these days with our food, drugs/pharma, health devices, other defective products, water, sea, air, mines, oil drilling, refineries, oil spills etc.
The list goes on on the various agencies whether at the local or state or federal level where personnel have been cut and it is not in our countries best interest. We have downsized police officers, firefighters, teachers, nurses, as well as other public employees that provide the oversight etc and this has been a trend over the past several years. We have elected foxes to guard the hen houses etc....Look at the results so far? LOL
THAT is why our health care costs are soaring, it has NOTHING to do with the GOP!
Gee, they are the typical persons to vote DEMOCRAT!
People have undoubtedly died for lack of medical care because of this. Charge them with aggravated murder the same as if a convenience store clerk was accidentally killed during a robbery. What's the difference?
Voter in LA- blame bush- predictable
To..Fedup.."""
""Government officials say the defendants from Baton Rouge rounded up drug addicts, homeless people and the elderly and used them to submit false claims for treatment."""
Who was doing the rounding up...? and who is the typical persons to vote democrat ...? the ones who are getting ripped off and used ..are going to vote democrat ..yes it all makes perfect sense
We really need National Healthcare.
Many audits were done during the Clinton administration as well. It was like rats leaving a sinking ship. They exposed so much corruption. It was all on 60 Minutes. Millions were recovered but no savings were ever passed on to the consumer.
Nothing was done during the Bush administration. Most doctors are republicans and the AMA has the strongest lobby in Washington so once again it was a free for all. Now there's a new sherriff in town (Obama) and he's cleaning house.
It cracks me up to hear republicans who regularly preach small government start harping about more regulation on doctors/healthcare/insurance/medical corporations. The ONLY way you could regulate it is with a National non-profit healthcare plan.
Doctors are narcissistic in nature. Little Gods. Throw in religion and you have got someone who can talk himself into just about anything. Your well being is at the bottom of the list.
The health care system is a total scam fleecing Americans at every turn. Corporate welfare at it's worst.
marinmom,
you bash docs on every single post you write....what is your problem?
The people involved in this scheme were not all docs, and the doctors here are in the minority. There are bad apples in every bunch. There are crooked cops, crooked judges, bad teachers--doesn't mean we paint them all with the same brush
You really need to get over whatever happened to you that created this anger...
On another note, I don't think burdening the 99% of honest docs with even more regulation and paperwork and leaving them less time for patient care is a good solution to try and control the bad 1%
Not blaming anyone just pointing out the facts that prosecution of Medicare defrauders has finally started kicking in and that the fraudulent billing started in 2005 (or at least it did for the ones here).
But one has to question why you didn't question the comment right above mine blaming the current administration. Precisely how did any party cause this? Some people are crooks. People of all political persuasions. But let's be realistic, it is only in the last 2-3 years that authorities have started to pursue the bilking of American taxpayers of 100's of millions of dollars.
Why not get behind the enforcement of something that will ultimately reduce our cost for healthcare?
"Most doctors are republicans and the AMA has the strongest lobby in Washington" , I hear chortling and gaffawing , please link some source for your claim , and Wikistupedia doesn't count , thanks
you do know that only 23% of doctors belong to the AMA , well of course you do , or you should
It's funny you say this, I wonder if anyone has ever gone to a prison and taken a count of who is what political party...? Now THAT would make an interesting article!
Ruken by all means have the government cut out all the medicare Social security and other human services. While they are at it maybe they can put exterminate all the poor and lame. What a better world it would be with only the rich and famous. (gag)
Those calling for a National Health Care System should realize that it would only make the fraud worse. If you think Medicare is bad, A National Health Care System would be Medicare on steroids
First the GSA scandal and now this. This is why I cannot, with good conscience, support raising anybody's taxes and giving these morons more to spend. Our government has proven themselves incapable of being good stewards with our money. They do not deserve more, in fact they need to be forced to work with less. Not one more dime.
Charge them with murder! Considering how much money these people stole, all of it could have gone to help people in real need. I wonder how many people died, due to budgetary constraints, becaus eof these scumbags?
Amunaka
Do you think the drug addicts, homeless and elderly committed fraud for FREE? They were paid to assist with the fraud. These are the people that receive government entitlements, something democrats love!
As soon as you added all the members of the Public Employees Unions with US Taxpayer paid $90,000 a year Retirements:
**********************BZe1 YOUR POST IS BULLSH!T***************************
Why do you think that there must be a cut to services in the first place.
For States and Local Economies: Local, City, State Governments keep increasing their Taxes to make up Budget Shortfalls due to the loss of Revenues including the loss of Property Taxes due to the "Mortgage Crisis" and large numbers of Foreclosures. These increases in Local, City, State Taxes are then added to the 35% Taxes one of the Highest in the World and chase Businesses out of the US to Nations with a total tax (all combined) of 6-9%.
To stop the Current Problem: President Obama by Executive Order Reinstates the Glass Steagall Acts. He already mentioned the 35% Taxes in his 2012 State of the Union Address and no one has done anything yet, other than the Local, City, States continuing to increase their Taxes, Fees and Licenses.
Federal: How do you pay for a previously NOT Budgeted for $1.7 Trillion to $2.1 Trillion President Obama Health Care Reform Act. Plus the almost $6 Trillion President Obama specific Policies and Executive Orders already Spent as Discretionary Spending, Additional Foreign Aid, etc..
Most people cannot even disassociate Insurance CORPORATIONS from the Medical Profession and you want what? And how are you going to get people to work for Free? You also have people that cannot even figure out basic everyday things like incandescent lightbulbs that are not frosted (painted white on the inside) produce more light, last longer (less reflected heat), less wattage to produce more light, and you want them to figure out solutions to what?
Just look at how much the Insurance Corporations, Medical Device Corporations, Pharmaceuticals made off of President Obama's Health Care Reform Act (aka ACA). After passage into US Law, by Law the Insurance Corporations got $67 Billion, Medical Device Corporations got $23 Billion, the Pharmaceuticals Corporations got $20 Billion. Again you want people to figure out WHAT??????
Even President Obama stated how much the Insurance Corporations that Manage Medicare are padding their Costs to make $17 Billion to $18 Billion per year as paid for by the US Taxpayers. And yet, most US Taxpayers cannot figure out that: Most Management is Outsourced to Private Industry. Insurance Industry IS NOT the Medical Profession. Insurance Corporations are the Problem not the Solution. The previous Government implemented Government Run President FDR Universal Health Care For All US Citizens Worked until the Insurance Corporations of Italian Organized Crime got involved thru Bribes, Lobbying, etc..
Again you want the People to Figure out WHAT??????
President Obama, Face the Nation, September 20, 2009:
Go line by line in President Obama's Health Care Reform Act (aka ACA) and show me where he did anything to stop this, Uncle Sam aka US Taxpayers paying the Insurance Corporations $17 Billion to $18 Billion as the Insurance Corporation Profits. (lame excuse, "but I don't have time to read the whole thing"; response to lame excuse, "but you have time to post uninformed posts on Newsvine").
Again you want the People to Figure out WHAT??????
Heck look at all the other posts saying that they voted and made Candidate Obama President, and they do not even know that the Rich Elitists of the Electoral College determine the President and Vice President of the US and NOT their "popular" vote.
You have people that do not even know that Social Security is a US Citizen Contributory Fund and NOT an "Entitlement" and that the US Politicians they hired (elected) stole and continue to steal the money and stick IOUs into Social Security as to why Social Security is going down the tubes.
And you want these people to figure out the Interrelated Systems Management Approach Relationships and Solutions to: US Economy, US Consumerism, US Trade Deficits, US Laws and US Policies, World Resources, US Military, US Military Foreign Military Sales, Historical Precedents, Alternative Energy, Transportation, US Manufacturing and US Industry, Predictive Modelling and Projected Timelines (like Logic Diagrams), Illegal Aliens, Advanced Mathematics and Symbolic Logic, US Education System, Logistics, US Government (and Foreign Governments), Group Dynamics and Individual Dynamics, etc..
To..Fed"""
Okay what percentage of that 450 million do you think they got ... victimizing ..kicking the down and out the republicans answer to everything
This is a play on words. It is the largest "one day" criminal indictment. Gov. Rick Scott's Florida Hospital was charged in a non criminal claim for around $200 million against the company as a whole, and no individuals were charged. I personally think, in the Scott case, it was so egregious that the folks in the Bush Admin were forced to take some sort of action. However, they did it in a way they could avoid criminal charges because Scott is one of them. At least now Obama's Administration has moved fraud of this type to a more serious level. And it's about time, too !
Let's all just face it, America is deeply corrupt and broken. Sad but true and this is just another indication of that.
oh, so it was OK for them to assist with medicare fraud? Are you nuts?
"much of this started under the previous administration" , laughable
this stuff has been going on for decades , but you just keep working your "Bush did it" angle , it keeps us amused
"Obama's Administration has moved fraud of this type to a more serious level" , ha more liberal line towing
What is the most disgusting part of things like this is some of the frauds get caught and shut down only to petition some judge who reinstates their license to keep on billing the government. One home supply business was run out of a closet at another business, news crew caught them they got shut down only to be back up and running in less than two weeks, same crooks on both sides of the paperwork.
To many government workers are just as big of crooks as those in this story, look at the ICE supervisors who just got caught and try and tell me those above them didn't know.
Nice story! Now let's see how many, or anyone gets any real prison time! Rangel got a slap on the wrist for filing a false tax return! How many of those who caused the financial disaster in our country went to prison? And how many of the laws that allowed those to "legally cause it", were actually changed to prevent them from doing it again? Our elected representatives took all the teeth out of the law prohibiting them from using their political knowledge to personally profit in the stock market. Why do you think they bailed out the institutions they had stock in? This isn't the fault of any party, or administration. All these financial scandals have been going on for many administrations of both sides. They're only making the front page now because of how bad things are in our country. When everyone was working, had a home, etc. everyone just accepted it as the usual way of politics. The problem we have is that this has been going on so long, those in our government honestly don't know any other way of running our government! The new guys in elected office are immediately informed by the seniors, that if they want to survive they'll go along with the programs already put in place by the senior members. And they, and their friends will be granted more, and more access to Washington's candy store that holds our tax dollars. These problems are so entrenched in the political system, that correcting them is almost an impossible task.This is not the fault of either party, it's the result of our entire political system being run without the proper checks and balances!
poster said: "We really need National Healthcare"
ha , ya , like we need to have scurvy
Don't blame the government agencies and workers for all of this. Much is caused by the "free market" thinkers, and a republican house of representative that do not want anything regulated.
However, have you seen those advertisings in tabloid magazines that says you can get diabetes shoes without cost by just filling out a little clip form and sending to whoever is doing the supposedly giving. There is no place for identity data. I wonder how they get reimbursed and how much???? How about those talking blood meters. I have a 6 y/o non talker that works just fine. Users are responsible too. But, any time a patient needs a service, there should be a doctor's certification required. There is much blame to go around, but $325 million dollars is nothing to sneeze about. Every little bits helps.
Shows the problem is not treating and helping people.
It shows corrupt businesses are the biggest problem.
Deluded Republican delusion: "business will always do the right thing"
But we don't need no government regulation !!!! If this kind of fraud is taking place on the Medicare side of things, you can just imagine how much takes place in the private sector.
We do need Medicare reform, but just deciding to slowly eliminate it is not the answer. I'm not a physician (damn it JIM) so I don't know the best way to deal with this. Payment per service leads to excessive services. Payment per patient would probably result in poor service. There has to be some kind of answer which will result in the nation getting what it is paying for without having to make some middlemen rich.
Right,blame republicans for another give away program thought up,promoted and legislated into existence by the Dimocraps!
business will always do the right thing
For their bottom line.
I kid, it is just a few bad eggs that ruin the image of business. Unfortunately those few also get the most media time.
Larry it's not "business" it's "government" that doesn't work. Good idea let the "government" be more in charge of our lives. They can't even run a war right, much less run our health care. The government gets robbed more than an old lady in a crack ally. Get real dude. Everything government touches turns to crap, look at our public schools, look at our food safety, look at our beloved Department of Education, such a success story. The Department of Energy was started under President Carter to "end our dependence on foreign oil", how's that working for you?
Your an idiot, this is a not a Republican or Democrat thing. It is a bad people doing bad stuff-thing. This is just one of the hundreds of govt run programs that is over run with fraud. Why? Because the govt is so buried in Red Tape, no one knows what is going on and it with all the govt regulations, they actually make it EASIER for someone to commit fraud.
@ JCB
And life under corporate rule would be so much better? Give me a break.
Dirp, I'll tell you what works, just go to the best cancer hospital in the world MD Anderson in Houston. Physicians / Surgeons are paid a "salary", not paid based on cutting people, using worthless tests just to run up your bill. They kill cancer, not run up worthless bills just to make money, which by the way is how Medicare / Medicaid is continually ripped off. Go to the best heart hospital in America, the Cleveland Clinic. Same thing, everyone including Surgeons are paid a salary, no needless do nothing tests and procedures that run your bill up and rob medicare, just the best survival rate in the world. That IS the answer.
Satanic, how's government rule working for you by the way? How's the "drug war" working for you?, how's the war machine working for you also? Get in line for your rations pal.
Hows paying out the ass for medical care working for you? How is spiraling cost of education working for your kids? Liking this recession much?
Government is not perfect. Nor is it necessarily even good. Corporate rule would be just as bad as government though.
There are rules and we need to make sure they are followed. Hence oversight committees. We absolutely need these watch dogs to make sure that bad apples don't give the programs bad names. You actually trust a company to do the right thing? That is an Utopian society and it doesn't exist!
"The love of money is the root of all kinds of evil" - 1Timothy 6:10
The key to this is education. Social security has been trying to help us learn to read the bills sent to them and to question what we don't understand or get. Families need to do this also especially for the edlerly that can't. If we all report this it helps. Also if people sell or allow their numbers to be used they should be cut off from services.
More examples of goverment waste, the goverment can not do anything with out waste. If it doesn't work kill the program and start over from scratch. Medicare is a sham.
It is the Rich REPUICKS that are defrauding the gov't dip weed
The government is the fraud, repub's and Dem's have nothing to with it. The current administration is the most fraudulent we have ever had.
Larry,
You're getting to the point. We don't need regulations that "stifle" our businesses. We need them to have the freedom to....................what, rip us off more?
To..la"""
No ..
@dirp
In the private sector there are incentives to weed out corruption and waste, primarily profit. There is no such incentive in the government, when there is not enough money due to fraud and waste some politician just comes along and promises more money. What wasn't mentioned in the article is just exactly how much money was spent discovering this fraud. My guess is that the investigation probably cost more than the fraud it uncovered. The fact of the matter is that if medicare was run by the private sector it would have gone out of business decades ago. This level of incompetence is only possible with the government, a private company could never survive throwing so much money away.
And finally I would like to ask you to share with us all just exactly who is calling for NO regulation? I won't hold my breath waiting for you to come up with an answer.
Actually, I don't think it would have gone out of business if it was run publically. Look at all the insurance companies that are doing so well. Like someone above said, it all comes down to incentive - and the gov't generally, has no incentive to stop fraud (the PEOPLE want them to but ...) A private corp will bust it's butt to prevent fraud - and is fairly successful doing so.
A private company WOULDN'T have thrown away so much money, so they would've survived just fine.
Bad example. If the US Government gave me (not a Loan) $67 Billion as stated in President Obama's Health Care Reform Act (aka ACA) I would be doing really well also. How much US Taxpayer Money has American International Group (AIG) Insurance Corporation gotten and do you know why they almost collapsed, once again the solution would be for President Obama by Executive Order to reinstate the Glass Steagall Acts to make the activities that almost collapsed AIG and the US Economy ILLEGAL.
Corporations, businesses of any stripe, have to innovate, have to stay ahead of the bottom line or they fail, simple. They also generally expand or contract to accompany the market that they are in: they cannot charge more than what people are willing to pay.
The Government, however, keeps doling out money. When they run out of money, they raise taxes or they borrow.
Want to see something interesting? Slash all government spending for spending on loans and medical for a little bit. Cut it down to nothing. Turn OFF the spigot. The universities, the hospitals, the places that depend on these endless streams will do one of a handful of things.
A) They will run up the costs higher (because of fewer students/patients) to make up for the shortfall. This will price them out of range and, once no one can pay those rates, they will fold. Hard.
B) They will cut corners to try and keep the rates the same and the profits the same. Quality will fail, customers (students, patients) will leave, profits will fall.
C) They will realize that they cannot sustain themselves at that level. Those who want to remain in business will; they will lower rates, offer better quality for a premium, trim costs and waste, and do anything in their power to bring the rates in.
I come from a family of antique dealers and collectors and, as a kid, I was always oohing and ahh-ing over the prices or "value" of things. One thing my dad drilled into me is something is only worth what someone will pay for it. You can ask for $100 until you're blue in the face, but if all someone will pay you is $10, it's worth $10. If you have a school or medical service and no one is buying your services, you've got no choice; you've got to lower rates or fail. As long as the government keeps making up that shortfall, they will keep high rates and raising rates.
Jenn,
No, the private companies wouldn't go out of business. They would have let lots of people die to keep their profit margins healthy.
This is a play on words. It is the largest "one day" criminal indictment. , Gov. Rick Scott's Florida Hospital (while serving as the CEO) was charged in a non criminal claim for around $200 million against the company as a whole, and no individuals were charged. I personally think, in the Scott case, it was so egregious that the folks in the Bush Admin were forced to take some sort of action. However, they did it in a way they could avoid criminal charges because Scott is one of them (a Republican). At least now Obama's Administration has moved fraud of this type to a more serious level. And it's about time, too !
@Jenn S-2267056
That was pretty much the point I was trying to make.
saying too much regulations cause fraud, is like saying too many policemen causes crime. The republicans do not like regulations, that is the truth. The republicans try and defeat regulations at every turn, that's is the truth.
As far as education and other look like failures, the states trying to educate on the cheap in the name of less or no taxes contributes here. They try vouchers and all sorts of things to defeat a quality education. Many times because they can't mandate religious superiority in public schools. To show they are disingenuous, look at how they regulate private and religious schools. Many of these institutions have no restrictions and state regulations, while public schools are regulated almost into oblivion. Here in Florida, religious and private does not have to be accredited and their students do not have to take assessment tests. So, everything is not black and white, we have to look further than the headlines to get the whole stories!!
It's bad enough that medical costs are so outrageously high in America, more so than in any other country. But on top of that, Medicare is being destroyed by the mind-boggling greed of some doctors, nurses, and hospital and nursing home management people who have no qualms about bilking it so they can get rich from treating senior citizens.
But...but...but...for them to not make a reasonable return on their educations isn't "FAIR," now is it?:>) Believe me, I agree fully with bringing these creeps to the bar of justice. I just wish we didn't have to pull money out of the pockets of honest, hard-working healthcare professionals.
Remember, "fair" is a four-letter word.
Complain and more complain and....then do nothing. Go back to your so called great jobs, with your so called work friends and live a so called "good" life.
This will all affect you and your kids one day.
What are you all willing to do about it?
I'll vote for Obama so more of this fraud will be uncovered.
This has nothing to do with Obama. A lot of it is done using computer tools looking for various fraud patterns. The tools are improving and btw generally developed by private companies under government contracts.
Sunset-330215
Or so more social programs can be created that are full of fraud. Obama is for expanding this type of program.
Nothing was done under the Bush administration. Nothing.
Millions were recovered under the Clinton administration. Millions!!!
Republicans are corrupt and the people who support them are blind.
IF the Doctors are guilty of Fraud then LOCK them up for 8 -10 years are what ever the fraud laws allow.
When you start locking people up for fraud the instances of fraud will go down.
Now their is no incentative to NOT create fraud. No one does anything about the fraud.
At a private sector insurance company (yeah, yeah the industry you libs love to hate along with oil, trucking, manufacturing, energy...probably missed a few evil industries), this type of fraud would not happen. When you have a bottom line to protect, fraud is quickly found and eradicated - not three years to find. Imagine the feds running the health care system in this country..the fraud would be so rampant it would virtually implode. But go ahead and keep thinking universal health care is the way to go.
It's funny how the old stereotype of "rich doctors" keeps getting thrown around here today. Yes, specialized doctors make good money because they are an exclusive commodity. And they AREN'T posting false claims to medicare etc, because they don't HAVE to. Just like top athletes, they get well paid because they have skills the rest of us lack.
Now your general practitioner, they make diddly-squat. After overhead, malpractice insurance, hiring a billing company to bill all the various insurance companies, they aren't left with much - and, yes, the $150k they make is more than many make, but they are hardly "wealthy!
The ones ripping off Medicare etc are the people who do the billing - and that ain't the doctors, pal....
To Juice"""
Who do you think is committing these crimes to begin with ...what do you mean it wouldn't happen in the private sector....
Like I said at post # 1.49, most US Citizens cannot disassociate the Insurance Corporations from the Medical Profession. The KNOWN Facts, removing the Insurance Corporations from the Medical Profession Results in an Automatic Decrease of 80% of the Costs of Medical Treatments. By having an Actual Government Managed (Not Outsourced to be Managed by the Insurance Corporations) Universal Health Care, like President FDR's Universal Health Care For All US Citizens, implemented during the 1929-1939 Great Depression, the Results were, instead of US Citizens having to decide between Food and Medical Treatments they could afford both, more spending money in the pockets of US Citizens to spend to stimulate the US Economy instead of putting the money into the pockets of Italian Organized Crime that owned the US Insurance Corporations, the Infrastructure implemented by the US Military Office of the Surgeon General (most US Citizens wonder why that position is a US Military Officer) and the US Military that created many Medical Professionals for the US Civilian Medical Profession as US Military Reserve Officers.
Are you calling President Obama a Liar?
President Obama, Face the Nation, September 20, 2009:
Go line by line in President Obama's Health Care Reform Act (aka ACA) and show me where he did anything to stop this, Uncle Sam aka US Taxpayers paying the Insurance Corporations $17 Billion to $18 Billion as the Insurance Corporation Profits. (lame excuse, "but I don't have time to read the whole thing"; response to lame excuse, "but you have time to post uninformed posts on Newsvine").
So now you want to discuss "The Cost of Justice", as whoever can afford the Costs can afford Real Justice. As Lawyers being "the other blood suckers".
You do know that is a Rhetorical Question with their answer, NOTHING except post more bullsh!t on Newsvine based on emotive popular opinions and not researched Facts (and Causality). I know what I did to make me very unpopular with many US Politicians; never ever tell US Politicians, "That they don't know sh!t about _______fill in the blank________." (eventhough, you know that they don't and that is why their staffers research then write their position papers).
Go right a head. LOL. Don't blame me for even bigger Fraud (Against US Constitution, Amendments, Bill of Rights, etc.):
Naomi Wolf: 'Obama can lock any US citizen up without trial'
http://www.youtube.com/watch?v=DLSeD19m3UE
marinmom,
Let's talk Facts. I just farted one of those really stink ones that brings tears to everyone's eyes, that is a Fact (everyone running away gagging and their eyes watering). And the other Fact that fart smells like your Partisan Political Campaign post. Give us Who, What, Where, How Many (How Much), When, Why (Motives), etc. examples: President Clinton gave China Most Favor Trade Nation Status to obtain Chinese Campaign Contributions as mentioned in his US Congress Impeachment as "Chinagate", later President Clinton used the Chinese money to establish his Clinton Foundation to make more money like holding on to the Haiti Relief Donations to gain interest on the Millions as profits. Or President Clinton regardless of the advise of the US Congressional Research Agency signed into US Law the 1999 Gramm Leach Bliley Act and 2000 Modernization Act to eliminate the Glass Steagall Acts and made legal those Causes of the previous 1907 Depression and the 1929-1939 Great Depression and also made Legal the Causes of the Current $60 Trillion to $100 Trillion "Global Economic Crisis" consisting of the "Mortgage Crisis", "Wall Street Crisis", "Financial Crisis", "Banking Crisis", "Credit Crisis", etc. as identical Causes, Effects (Symptoms), Results, Indicators, etc. to the 1929-1939 Great Depression.
marinmom,
You can keep on worshipping your false Messiahs and I can list pages of all the proof of their bullsh!t that they Caused regardless of being Demoncraps, Repugnants, Scrotums (Tea Baggers), In Depends (Full Adult Diapers).
That is done by those that cannot even add two (2) nickels ($0.05) together to equal a dime ($0.10).
And you think that they can even figure out the very Greedy Insurance Corporations effects of their Medical Malpractice Insurance Costs to Medical Professionals in relationship to their Final "Take Home Pay".
These are the same so called US Citizens that allowed the US Politicians that they hired (elected) to be bribed by the Insurance Corporations to allow the Insurance Corporations to get into the US Military Health Care resulting in the US Military TriCare Insurance, instead of Free Medical Care for US Military and their Dependents;
While these same hypocrites scream "Democracy", "Freedom of Speech", "Constitutional Rights", etc. except for the US Military that is protecting their "Freedoms", "Democracy", etc. from those that would take that away (example: research Shia Laws, aka Sharia Laws), so the US Military cannot complain about having to pay for Medical Care that was previously Free (provided by the US Military Medical Service Corps Doctors, Nurses and other Medical Professionals as Reserve US Military Officers, NCOs, Enlisted; and managed as a Non Profit (break even, zero gains zero losses) by the US Military Medical Service Corps).
What really makes me laugh is that US Civilians believe that something that they pay for (partial or full) is a "Benefit". When did a Free Benefit as part of Employee Benefits become something paid for partially or fully (Rhetorical Question, I already know, when the Insurance Corporations brain washed the US Public to squeeze more money out of the US Public thru automatic payroll deductions. Just like the other Organization owned by Italian Organized Crime the US Labor Unions and their automatic Union Dues payroll deductions based on Earnings. Anticipating the uninformed saying "Union Bashing", Unions created the Middle Class, Workplace Safety, etc.. Wrong go research those measures implemented by President FDR during the Great Depression after he suspended all US Labor Union Activities.).
Keep digging and call past employees who were laid off and quit
Most of the fraud comes from false start-up companies that claim to be providing services, people apply for them, the companies collect money, then never provide services or equipment. We need more oversight in billing practices. A simple "services/goods received" receipt from the recipient would probably suffice pretty well, as long as we had some way to audit.
My belief is you defraud medicare or Medicaid you and any professional associated with it loose your license and can not practice or do this type of work in the United State ever even after you get out of jail.
They should loss their right to receive benefits from these programs as well.
It wouldn't matter either way. The government is so inept at finding/preventing fraud that the risk of reward far out weighs the risk of getting caught.
Why should good Christians in a good Christian country try and defraud their country without a conscience, and the Christian citizens blame the government instead of the offending businesses. What's wrong with this riddle and why can't we solve it????
I allege $16 trillion plus in Fed fraud schemes.
...Oh yeah. I went there.
Uncover one fraud source to hide another....obama and holder are the biggest frauds of all!.
Funny how the Bush administation had their head buried so far up the ... they didn't see ANYTHING.
Not true. The point is the ability to find the fraud has become easier.
Government fraud has been going on for the last 45 administrations or so. It was never limited to one party or another. Neither was it limited to Bush. It's simply a part of doing business with the government.
Yours sir is misinformation and a by for the corporations--plain and siple!!
Online systems have increased the potential for Medicare fraud as with IRS fraud.
It is really encouraging to see the government taking actions to catch these people and bring them to justice. Medicare is a good thing and those who abuse it are stealing from all of us.
One physician over billed me for services and I made a complaint and it was not only investigated, however, the payment was denied. I was impressed with the speed of the investigation and that I was heard.
I can't help but think single payer would eliminate many opportunities for fraud
Only if it is not the Federal government. You need to rethink your comment; there is a major fallacy in it. Remember, government only leeches money out of the income stream; it does not add value to any program.
Money is sent to Washington (or your state capitol) and much less money is returned to you locality because of all the program administrators that must be paid.
bob, I'm not sure if you're correct. Some states get far more out of their federal tax dollars than what they put in. I'm pretty sure Alabama takes in more than a dollar for every dollar they pay in.
And the argument that the Federal Gov doesn't add value to any program seems to be excessive. Doesn't the federal government pay for our armed forces? Didn't the federal government put a man on the moon? Didn't the federal highway system add value to our country? Or did it hurt? NOAA? Judicial system?
My argument was that with less money transferring from one place to the next a bunch of times, like you said, costs money with administration.
So if there was single payer there wouldn't quite as many administrators sucking money out of the system.
The Social SecurityAdminstration operates with a 1.5% overhead while insurance companies (counting profit) skim 12-15%. Both do essentially the same thing - collect and disburse, and roughly the same amount of dollars annually.
So who is leeching more from you?
If anyone is leeching, it is the 500 in Congress whom we re-elect with uncanny regularity!
Of course the govt is a cost center. You expect them to be a profit center? Come on! Every company in the world has a cost center. Why would the govt be different? This is the point of needing oversight.
WHAT!!! Imagine Medicare x the whole country. The government is far to inept at finding/preventing fraud.
m,
There's some fuzzy math in there. The SSA has the IRS as their accounts recievable office. They do not have to count those collecting expenses in their budget. This and various other reasons account for the illusion of efficiency in govt programs
Ask yourself this: did you ever walk into ANY govt institution (the post office, the DMV), and find yourself blown away by the efficiency of the operation?
eric-2573068
Did you ever walk into any insurance company?
Were you blown away by the speed with which they send out your benefit checks, or with the opulence of the offices?
PS: the fuzzy math also ignores all the doctor's staff (and patients) who do the filing, checking and correcting of "rejected claims". That's their IRS (and we pay for that too, or did you think it came gratis?)
Im no lover of private insurance either. But yes, I think they work quicker than the federal govt
Im not sure if you understand the point. Drs offices do filing, checking, etc of "rejected claims" for both private insurance AND medicare/medicaid. So the cost there is the same. My point is that the IRS collects taxes (ie income) which finances govt programs like medicare. Thus, medicare, SSA, etc can wash their hands of the expensive business of collecting revenue to finance their operations. So, even thought the govt as a whole is still employing thousands of people to do the job of collecting, they can make it look like, at least on paper, that certain programs cost much less to run then they actually do by reassigning some of their operating expenses to other umbrellas
Heres a link to help clarify. By the way, I do not view forbes as the end all-be all source, so if you have a more authoritative one, by all means, share it:
http://www.forbes.com/sites/aroy/2011/06/30/the-myth-of-medicares-low-administrative-costs/
Single payer to who are you paying? As soon as you say Insurance Corporations, see post#3.11
Go see post#1.49 as to who manages that and how much in profits they get from the US Taxpayers as what President Obama, Face the Nation, September 20, 2009 said.
M. Onger,
To prove you point you must mention what happens when a Doctor, Nurse, Medical Professional defies what the Insurance Corporations dictate. The Insurance Corporations increase that Doctor's, Nurse's, Medical Professional's Medical Malpractice Insurance to become Unaffordable therefore that Doctor, Nurse, Medical Professional can no longer be a Doctor, Nurse, Medical Professional. Insurance Corporations long ago lobbied, bribed, influenced US Politicians to make it illegal for a Doctor, Nurse, Medical Professional to practice without Medical Malpractice Insurance.
I can tell you this. No business including Forbes have an accounting department in each department they possess. Just like the government, they too have one central collection agency to manage their accounts receivables. So I fail to see your point. I think most prudent businesses and governments try and consolidate like task, thus, eliminating duplications, as well as establishing one line of responsibility. This usually save money and remove excess personnel. Why is this a bad thing????
In a small town of 20,000 in Central Michigan, a small Pain Clinic has been closed due to suspected Medicare/Medicaid Fraud. Greed seems to be the down fall of all Great Nations.
What's so hard about programming your system to kick out a notice to review the claims of a Doctor or clinic who files claims out of norms set by all the other claimants ? And change the name from Baton Rouge to New Orleans. Betcha the crooks were from NO but moved to Baton Rouge after Katrina. 5 of the 7 cities mentioned are in the deep south (including LA). What is it with the warmer climes ? No NY, Cleveland, NJ, St. Louis. Boston, Philly, San Francisco, Seattle, Denver ? Miami has had major busts every few months worthy of Nat'l news reporting for decades with their corruption. FEMA Miami office paying millions in claims to people who weren't within 110 miles of a hurricane.
A lot of "english deprived" clinics in Miami and Los Angeles! I bet one would find the same is true for the other cities on that list!
Fraud detection systems are becoming more sophisticated. Still a ways to go but improving. On the other hand payments should be outcome based not just on how many tests are run. My aunt on Medicare had to go to an emergency room because the nursing home staff was unable to reinsert a catheter which happens from time to time. By the time the ER was done with her she had electrocardiography and a bunch of other tests for no apparent reason. She is 91 and we are always afraid to have a hospital involved because there will be unnecessary tests and treatments that would not make sense for a person of her age and one who does not want extrordinary measures taken.
@lulu98:
I'll wager that if your 91 year old aunt had died without the EKG you'd be rattling a lawyer and screaming "MALPRACTICE".
JH749: not in Florida. The legislature about 10 years ago or so, passed a "we hate your elderly relatives" law. IF someone kiils your mother through negligence, including med mal and she is above a certain age ( I think it's 76) the relatives are barred from suing. If you are her legal guardian you can't sue the neglegent people. They didn't want juries awarding money against insurance companies for old ladies who die at the hands of others. They thought this would upset the economy or something. OF course they were right, Florida is in the top rank of states with the highest unemployment and the highest foreclosure rates. They did a good job of protecting Floridians. Perhaps if their brain power were spent on education and economics instead of protecting ins co.s that don't need it Florida would be in better shape.
Which goes back to my riddle above. How can we have so many crooks in a Christian nations. Are the preachers doing their jobs, or do the people not believe in them and what they teach???? I don't have answers but tons of questions????
Good job Feds!! I would start with the CEO of some companies and see what they allow and see how they are related to their employees are not qualified to there jobs...but I guess it makes a good cover
Wow do i see a pattern here...
is this what the repubs were complaining about when they claimed Obama wanted to slash 500 billion from Medicare
POLITICO
Obama announces effort to crack down on Medicare and Medicaid fraud
Obama announces effort to crack down on Medicare and Medicaid fraud - Live Pulse: Obama announces effort to crack down on Medicare and Medicaid fraud
March 09, 2010
White House
President Barack Obama tonight announced a plan to crack down on fraud and abuse in Medicare and Medicaid ahead of his remarks on health reform in St. Charles, Missouri on Wednesday.
Delivering remarks on health insurance reform in St. Charles, Missouri, President Obama discussed a new effort to recoup taxpayer dollars through the use of payment recapture audits, which offer specialized private auditors financial incentives to root out improper payments, and have been demonstrated through pilot programs to be highly effective. In fact, expanded use of payment recapture audits could return at least $2 billion in taxpayer money over the next three years– double the current amount of projected recovered costs.
http://www.politico.com/livepulse/0310/Obama_announces_effort_to_crack_down_on_Medicare_and_Medicaid_fraud_.html
91 charged with Medicare fraud across U.S.
By Jerry Markon, Published:
September 7,2010
The Obama administration escalated its crackdown on health-care fraud Wednesday, announcing charges against 91 people in eight cities who are accused of bilking the Medicare system out of nearly $300 million and victimizing the elderly and disabled people who rely on the federal insurance program.
http://www.washingtonpost.com/politics/91-charged-with-medicare-fraud-across-us/2011/09/07/gIQApV7DAK_story.html
FOR IMMEDIATE RELEASE
Tuesday, August 23, 2011
Owner of Miami-Area Mental Health Care Corporation Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme
Defendant Found Guilty of Multiple Fraud and Money Laundering Charges
WASHINGTON – A federal jury today convicted a Miami-area owner of a mental health care company, American Therapeutic Corporation (ATC), for orchestrating a fraud scheme that resulted in the submission of more than $205 million in fraudulent claims to Medicare, announced the Department of Justice, FBI and Department of Health and Human Services (HHS).
http://www.justice.gov/opa/pr/2011/August/11-crm-1074.html
Government triples money recovered from Medicaid scams
By Kelly Kennedy, USA TODAY
Updated 10/19/2011
WASHINGTON – The federal government has more than tripled the amount of money it has recovered through efforts to stop Medicaid fraud in the past six years, records show.
In 2004, the government gained $573 million through fraud prosecutions, compared with $1.85 billion in 2010, according to records from the Department of Health and Human Services inspector general's office. That was spurred by a 57% increase in the amount of grant money to state Medicaid Fraud Control Units (MFCUs) from $131 million to $205.5 million.
http://www.usatoday.com/news/washington/story/2011-10-19/medicaid-fraud-money/50831614/1
Feds: Texas doctor among 7 accused in largest health care scam in US
By msnbc.com staff and news services
Feb 28 2012
DALLAS — The owner of a Texas-based medical service provider is among seven people indicted in what authorities say is the largest health care fraud scheme in U.S. history, bilking Medicare and Medicaid of nearly $375 million.
http://usnews.msnbc.msn.com/_news/2012/02/28/10531492-feds-texas-doctor-among-7-accused-in-largest-health-care-scam-in-us
At the same time,more individuals were placed on Medicare and mediciad since Berrie took office than ever before!
Before you post Newt's erroneous drivel check your facts. Yours are wrong.
mas089
And more with the next President, and even more with the one that follows.
You cannot blame a 40 year old guy for all the aging boomers turning 65. That's kin'o stupid!
Thank you for posting this. It makes me laugh the people who think Obama just did this in the last few months to win an election. Short memories.
I laughed my ass off reading the comments. I work in the healthcare industry. Every day I fight with Medicare to get VALID MEDICALLY NECESSARY claims paid for seniors and the disabled. These so called "fraud units" are a joke. If they really knew what the hell they were doing they would have started this "crack down" decades ago and targeted valid fraudulent providers. The only good thing I can say that these independant contracters are doing is stopping the "pay and chase". This may look good on paper especially to the morons who want to talk about stage four cancer patients getting hip replacements (seriously?). I can tell you this. The contracters are refusing payment of three times as many claims THAT ARE VALID as they are that are fraudulent. AND THEY HAVE A FINANCIAL INCENTIVE TO DO SO. 70% of the "fraudulent" payments goes in their pockets. Meanwhile they are clogging up the claims processing and appeals system, and soon noone will be accepting Medicare as an insurance. That will be what ends Medicare as we know it. Not some nearsighted Republican budget.
Amunaka, I wonder if Mr. Holder is checking out Mr. Bachman's Medicare billing.
It looks to me like Obama is following through on something he promised.
LOL You couldn't wait to make this political, could you FLOYD? Bet you also want "smaller" government, ESPECIALLY any kind of watchdog group, so this kind of thing could go on, and on, and on.
Well, you went there, now go back to where you were before that, or just go away.
Arrrgghh post 15 was actually supposed to be reply to post 7, reply button malfunction. Also was supposed to be be "political SLAM" rather then just political. Need more coffee.
oh well, great post from Amunka, anyway. Seems he had his coffee first.
i think a much more compelling question is how much medicare funding is lost/wasted BY OUR GOVERNMENT. obviously we'll never get the "correct" accounting on that, but i'd be willing to bet that the $450 million that they've "exposed" as fraud isn't even a drop in the bucket when compared to the $'s lost due to the colossal mismanagement and general ineptness by our govt in this program.
To..sebrad""""
Right and let the private sector take care of the fraud ....oh wait ..who is that's ripping off the government to begin with ....
Right on! It will be fun watching sebrad answer this riddle!!
no problem, charles/amunaka. wish i had seen your reply sooner.
there will always be people trying to "get over"...not much can be done about that. in this case, consider the $ already stolen GONE and forget about it, unless it can be recovered relatively easily. next, fire everyone (and take their pensions away to help backfill the $ stolen from the fund) on the govt side (in phases so that proper staffing won't be a problem) that can be attached to either fraud/improper approvals/failure to meet protocols, etc. next, any provider that can be attached to these improper payments should be investigated and if it turns out there is a pattern of abuse/other incriminating evidence, take their medical license and put them in jail for at least 15 years, no early release. as part of this effort, stiffen the law regarding medical billing fraud so that loss of practice/license and extended jail time/hefty fines are guarantees for offenders in the future. the pension $ received from those govt employees can also be used to help build a new prison or two to house them.
enforcement in the future: the stricter penalties for providers should prevent the "nickel and dimers" from attempting. the big thieves will still continue to try regardless. my suggestion: any time a payment of more than (say) 50k to a provider is to be made, multiple internal signatures authorizing said payment must be had in order to release. additionally, video evidence that certain (very costly) procedures were actually performed must accompany the claim for payment. finally, the patient must confirm they received the very costly procedure before payment will be released. the patient, if convicted of fraud under my new rules, will also spend several years in prison as well. internal to the govt, anyone that authorizes even one improper payment gets to repay (fair and equal portion, depending on how many involved), loses their job and goes to jail.
finally, who monitors, and how?: haven't figured this all the way out yet, but a big 4 acctg firm should be doing the forensics on this stuff quarterly. any fraud that they expose should be rewarded with a $50k bonus. penalty for them being in on the scam: disbarment and loss of license for the entire firm and 25 yrs in jail and $1million fine for all participants. reporting and forensic acctg results posted to a public records "forum" online so everyone can see.
maybe, chuck, you'll respond; maybe you won't, but here's the point: stealing from the govt should be considered similar to an act of treason, and the punishment should fit that standard. i know if someone told me i could steal $20million and only face $2million in fines and 5yrs in the big house and i'll be out in 1yr IF I GET CAUGHT, i would ask "how many times a day can i do this?" if it's painfully obvious that IF you get caught your life is DEFINITELY, beyond any shadow of doubt, ruined, MOST will elect not to try. some still will, but once a few of those guys get the beatdown and become the known, public examples, my guess is the problem will be all but over...
This is wonderful!!! I must say finally something Holder may be doing right. Just took 3.5 years.
Investigations take longer that the "snaping of a finger" john.
I think this just shows something that I have thought for a long time, the only reason that the federal government is so screwed up is that people screw them over every chance that they get.
Amen! It's not the government that is crappy and greedy - it's people who cheat. THOSE are the ones that screw us all.
Give the man a cigar and a gold star. Yes sir, now, we are starting to solve the riddle!!!
1. Have Every Medicare check over a certain amount be delivered by the FBI direct to the office-if the office is a PO box send the check back to medicare and take the "company" of the accepted vendor list and put it and its "owners" on a blacklist.
2. Make certain Medicare services recipients (patients) gets a detailed copy of what was spent on his behalf, have him/her/caregiver review the documentation. Everything on the bill that was not provided should be returned to a frauds claim department for recovery and payment of a 10% reward to the fraud finder.
These two things alone - advertised properly should go a long way in reducing this crap.
Really fed up -- Many completely legitimate health care operations receive their payments through a central mail handler which uses a box number for an address. They are not, however, just mail drops.
On your second point, i agree, but the detailed copy is only understandable by another doctor's billing department.
Fed up - First: the POB that many vendors use are actually used by banks. Second: Medicare patients do receive monthly statements. They show the premiums paid, the services given and charged for, which insurance party paid what, and if there are any copays due. Diligent patients reviewing these statements help reduce fraud. Third: Many medical services (health provider services, medical supply services, transportation services, etc) as vendors, don't answer to the patient. They bill the short term or long term program that Medicare sets up.
The point here is to make it difficult for crooks to cash in - I was not born yesterday 1pov I don't need a lesson on how Medicare works having taken care of my in-laws for the last 5 years of their lives and dealing with such incompetence as my father in law being billed for services of an OB-GYN and when reported to medicare was told it would be too expensive to try to recover the $1500. It is unfortunate if a few good businessmen get stomped but they need to be an active part of the solution not a passive acceptor of the status quo.
When a program is subject to between $80 billion and $100 billion of taxpayer money it is long overdue for us to take very harsh action - if y'all can not understand that simple fact then too flipping bad.
Okie, I demanded a detailed billing on my in-laws payments - I was able to understand it very easily. I remember a box of cleanex billed at $10. And the "rent" of a remote control for the television set at $15/day and such other BS. Stupidly high prices? Yes! But that is how hospitals recover the cost of dealing with freeloaders.
And, the so called mandate to have freeloaders pay their share is a just one. Now, let's hope our Christian Supremes of our Christian Nation agree with that notion???? I think they will--well one can hope can't he????
they have to start to crack down the home health care system and hospice services, these people are sucking out of taxpayers money.It is very expensive services where some individuals are becoming very rich in very short time. the government should go after them I think and close them out.
Nice guy, don't know where you live but when we asked for home health care in Virginia it "was not available" and we paid for hospice care out of our own pockets. I can tell you from first hand experience even with insurance extended elderly care can demolish any thought of retirement - thank you America from one who has done all the right things and still wound up "un-comfortable" in my "retirement" years. Go ahead and send my money to the poppy fields of Afghanistan and to hell with your own people!!!!!
If you think fraudulent practices are rampant now...
Wait until Obamacare is thrown into this mix.
"Obamacare" as you call it has REGULATION built in. Just try to cheat the taxpayer under A Democratic President.
You are kidding me, right???
NOBODY even knows what all is entailed in this over 2000 page bill.
To..lestwe"""
What a nonsense talking point ....
We have to pass the bill so you can find out what is in it,"
Nancy Pelosi
March 9, 2010
Well then how come the repubs came up with so many amendments to it back in the summer of 09 if they never read it
What do the GOP amendments to this Senate health care bill actually say?
By Christopher Beam
Posted Thursday, July 16, 2009
(snip)
That said, some context: Of the 788 amendments filed, 67 came from Democrats and 721 from Republicans. (That disparity drew jeers that Republicans were trying to slow things down. Another explanation may be that they offered so many so they could later claim—as they are now, in fact, claiming—that most of their suggestions went unheeded.) Only 197 amendments were passed in the end—36 from Democrats and 161 from Republicans. And of those 161 GOP amendments, Senate Republicans classify 29 as substantive and 132 as technical.
Yet many of the GOP amendments on this incomplete list do seem pretty substantive. For example,
http://www.slate.com/articles/news_and_politics/prescriptions/2009/07/this_is_what_bipartisanship_looks_like.html
Obama care will be a disaster because the government touched it.
TryReality - That was a really good joke. Still laughing.
This is stuff that they need to come down hard on. Don't plea these out. Send a loud message.
They should also imprison the govenment dolts that write checks for sevice not performed.
So you're saying REGULATION is needed? That a boy.
Exactly. Someone needs to regulate the government.
Yeah that makes sense, when a con man gets away with fraud, arrest the victim. :rolleyes:
450 million is nothing compared the medicare fraud perpetrated by Gov. Rick Scott of Florida. He defrauded the medicare system of 1.7 billion as the CEO of Columbia Hospitals. I am almost positive he committed fraud to get elected as well. Florida is famous for the Koch Brothers involvement in elections. Sen. Marco Rubio spent 283,000 of his campaign's funds on personal items and failed to return 87,000 that remained after he was elected. Afterall, isn't Florida the number 1 state for cases of fraud.
I am happy to hear that the feds are catching these cases of fraud. Hospitals have been committing medicare fraud for decades and decades. This is why the system has issues. Not from the individuals who depend on it when they retire. I think the GO would be happy to see those who have worked their whole lives living in shacks for their retirement since they basically stole most peoples retirement funds through the housing crisis. Not only is the equity gone from their homes, the stock market crash depleted their gains from their investments.
I'm sure that other large organizations who own a number of hospitals are just as guilty of fraud as Rick Scott was. Trillions of dollars have probably been paid to these hospital conglomerates.
What was it F. Scot Fitzgerald said in The Great Gatsby" Oh right!' The rich make a mess of everthing so that the rest of us have to clean up after them". or something to that affect.
God Help Us All !
Don't you think they should catch this stuff before they write the checks?
You are SSOOOOOOOOOOOOOOOOOOOOOO damn right.....
A 5 year scheme netting $225 million the tax payers will never get back. Why should it take so long to see this happening? Typical government bureaucrats not questioning anything and blindly spending OUR money.
Diane R,
I wonder if Eric is checking into Mr. Bachman who I understand claims he can cure homosexuality and charges Medicaid for his services. Hmmmm!
who, me?
you are so right and thank you for reminding us. It was reported that Gov. Scott invoked the 5th amendment 75 times, I believe. Wonder why he was not taken before a grand jury where he could not refuse to testify???? They do this to low life drug runners when they want to ensure a conviction. Surely, there are not two justice systems in our country???? I wonder what our justly Supremes would say about this riddle???? Just saying!!