Health Care thoughts: Leave the gun, take the cannolis
Tom aka Rusty Rustbelt
Health Care: Leave the gun, take the cannolis
A few months ago I posted about the changing face of health care fraud, and especially about fraud committed by non-providers – such as non-existent durable medical equipment shops.
These groups often combine computer hacking, identity theft and bill-and-run phony front offices.
Today (13th) the federal government arrest 73 people charged with racketeering for creating more than 100 phony clinics in more than a dozen states and billing Medicare and Medicaid something like $163 million. The crooks, allegedly with an Armenian “godfather” in charge, stole the identities of both doctors and patients before blitzing the feds with phony billings from non-existent clinics. The “godfather” is in lockup today.
Meanwhile the feds are auditing legitimate providers with contract auditors and cranking up requirements for compliance work. Maybe the feds should pay more attention to internal controls before paying crooks?
Tom aka Rusty Rustbelt
Some of the largest Qui Tam awards have been on medicare/medicaid fraud cases. Enforcement does need to increase since Qui Tam means some private citizen has done the leg work to bring the case to US District Court.
It is much less frequent in military ineptitude contracts, but happens on occasion if the referrant is not ruined by whistleblower retaliation.
The problem is that medicare is designed to pay first and ask questions later. The alternative would lead to concerns that the government is getting between patient and physician. Durable medical equipment is a scam in general, for example oxygen machines can be bought on the web for 3 months of what medicare pays for them (same brand and model number).(At least in 2003). Every time congress trys to put this stuff out for bids the durable medical equipment folks in each district come down on congress to stop this theft from them. (This is a real special interest story but never gets enough play)
Yep, y’all, DME is a racket, pure and simple. It’s a racket even when people who need the stuff and actually get it. Since the patient needs the walker, he’s going to buy it no matter what it costs. You can get some pretty nice, well designed walkers or you can get poorly designed walkers for the same price.
No rentals. No buy-backs for short-term users. No competition in small towns where there are only a few preferred providers. No community organizations renting equipment at a discount, etc. etc. And, of course, if you have a nice big hospital outfit with ambitious plans for expansion, guess who outsells all competition and isn’t open Saturday. And, then, of course, we have the Scooter People. It’s the Wild West, capitalism at it’s best. NancyO
i was just noting the other day how one of the political parties has come to look like its being taken over by the criminal end of the direct mail / telephone / email scammers.
then, just to be sure i got the whole message, i got a direct mail from the other party in classic scam form.
Well, maybe America has always been run by snake oil salesmen, but i’m sure they weren’t this obvious for most of the past fifity years.
maybe we are getting the government we deserve.
Coberly, NO ONE deserves the yahoos and scalliwags going around these days! We have our faults, but being required to put up with this stuff is over the line. NancyO
And that 80% of premiums must be spent on actual medical care….some of the 20% is spent on rooting out these frauds. Amazingly, the FBI’s costs in rooting this out won’t be included in Medicare’s costs.
Funny that, isn’t it, how all the costs of Govt run health care aren’t included as part of the costs of Govt run health care. One might almost think that people aren’t comparing like with like.
I wonder why that could be? (:-) )
Tim–The FBI is not usually involved initially in Medicare/Medicaid fraud investigations. Usually, it’s the IG of CMS that has the lead and turns up the initial suspected violators. It’s not very hard to figure it out. The Medicare carriers don’t burn up the road looking for fraud. Their job is to pay out the providers.
But, CMS has staff in all federal regional offices and can google like anyone else. SS offices are out in the flyover zone and can provide verification of brick and mortar presences or the absence thereof. The states’ bureaus of investigation have an interest in this and cooperate with the feds as does SSA’s IG. The FBI comes into to it toward the end of the process when the arrests are made. However, this is true for all federal programs. The agency does the basic leg work, then the DOJ/FBI takes over at the end of the process. Every part of the govt. depends on the DOJ/FBI for assistance in criminal or civil actions. No agency breaks out that cost. No biggie. NancyO
Note that some DME is purchases (and advertised extensivly) such as scooters (see the Scooter Store adds) and others are leased. Scooters are purchased and what happens afterwords is not clear. My mother got one and later died, we gave it to the local old age charity. It seems that there must be a way to rehab the units, so that they should be on a lease purchase basis from Medicare, such as 36 months or so.
Yet O2 equipment is leased.
Victims should always pay [for] the con artists’, frauds and extortisits who prey on them, and fund the law enforcement agency to hunts them down and prosecute them.
It is like in Asian countries, an outsider is at fault if victim of a crime or tort because they are there to be harmed.
I do not think that is US or English common law, but you could explain.
Today (13th) the federal government arrest 73 people charged with racketeering for creating more than 100 phony clinics in more than a dozen states and billing Medicare and Medicaid something like $163 million.
They got caught after making off with only $163 Million? That’s some crack work by your government run health care insurance company!
Meanwhile, in other news, CT health insurers hikes up to 47%…… The reason for the increases is the new federal health reform mandates, according to Anthem and the state Department of Insurance…..
Same reason private companies hate transparency, and electionioneering money gets to be undisclosed….it is a human thing.
Lots of laughs…again, plenty of crooks to go around. On the other hand, look at the history of rate hikes in the last twenty years say in MA…or your own state. And look to the election campaigning of companies and rate hikes by insurers for this midterm…how is that automaticly an indication of anything but politics??
how is that automaticly an indication of anything but politics??
If you read the quote from the link, the most important part of the quote is in bold here:
The reason for the increases is the new federal health reform mandates, according to Anthem and the state Department of Insurance…..
They have justified the increase to the state with actuarial projections, not politics And they had to show their work.
‘americanthinker’, try a better source.
The reason the old folks’ insurance deliveries are in the position to be ripped off; the ‘Anthems’ don’t cover them.
The ‘excuse’ for some of the headline’ price rises is the fact that health care delivery reform threatens to make the insurance companies cover health insurance as a public good with fewer classes eliminated from the service.
You need a better point.
Besides ‘let them eat cake’.
Romneycare has failed to get the MA hospital association (with the big five) and the health insurance companies (90% Blue Cross and Tufts) to volunteer cost control measures that appear to work on the end result.
The hysteria around this issue appears to prevent real solutions even being proposed to discuss.
I wasn’t claiming these were not arcturial projections. But the history of such is quite checkered.
you are so gullible.