U.S. Charges 107 With Defrauding Medicare

Posted by Kendall Harmon

Federal officials said Wednesday they had charged 107 people across the country in recent days for allegedly running a string of unrelated Medicare fraud schemes involving a total of $452 million in false claims....

Among those arrested were seven people in Baton Rouge, La., who were accused of recruiting elderly, mentally ill and drug-addicted patients from nursing homes and homeless shelters. The suspects allegedly signed up the recruits for mental-health services billed at $225 million over six years that never were given or were medically inappropriate, according to officials.

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Filed under: * Culture-WatchAging / the ElderlyHealth & MedicineLaw & Legal Issues* Economics, PoliticsEconomyThe U.S. GovernmentMedicare* TheologyEthics / Moral Theology

Posted May 3, 2012 at 7:00 am [Printer Friendly] [Print w/ comments]

1. SC blu cat lady wrote:

People wonder why healthcare is so expensive. This is part of the reason- fraud!  Less fraud would mean more actual legitimate claims would be paid.

May 3, 9:07 am | [comment link]
2. GillianC wrote:

The same charges were brought against a Planned Parenthood association in the Gulf states recently - though I am truly shocked that there is no MSM coverage of that lawsuit. 

May 3, 11:36 am | [comment link]
3. Clueless wrote:

Back in the days when I was in private practice, I lost money on all my medicare patients (and even more on the medicaid patients).  I also had to wait 6 months to collect the below cost payment, and comply with numerous rules including electronic billing, and medicare’s insistance that I not see any uninsured for free without billing them since this too was considered “medicare fraud” as by seeing the working poor for free meant that I was no longer giving medicare the “lowest price”.

The solution to the fraud reported in this article (and it does look like fraud, I’m sure there is plenty of it) is to have patients pay directly - cash on the barrell, and have medicare reimburse the patients after six months, instead of the physician. This will result in lower overall costs, will ensure that patients will monitor costs and find ways to lower them, either by deciding that they really DONT need an MRI if the doctor says their examination is normal, or by shopping around for the cheapest provider so as to lower their out of pocket expenses. 

I suspect that the above system will be the end result of this new attack on Medicare fraud, and that this is why the sudden new publicity.  Sounds good. I’m game.  Bring it on.

May 3, 12:11 pm | [comment link]
4. Mike L wrote:

Prosecute them to the fullest. But really? $225 million over 6 years is a drop in the bucket over the real problem with rising healthcare costs. Recently the NY Times reported in 2010 alone hospitals incurred over $39 billion in uncompensated emergency room charges. I’m sure they just ate it rather than passing that along via rising costs to those of us who do have insurance. I’m sure.

May 3, 12:13 pm | [comment link]
5. Yebonoma wrote:

I’ll know that Obamcare is finally working when my monthly health insurance premiums drop below the monthly amount of my home mortgage.  I’m not holding my breath.

May 3, 7:38 pm | [comment link]
6. clayton wrote:

#2 the government did not pursue the allegation, which was brought by a former employee (who would receive a percentage of any settlement).  So the story that wasn’t reported isn’t, Fraud at PP - it’s Former Employee Makes Unsupported Allegations.  Hardly a conspiracy to oppress the truth.

Also they were accused of billing for ineligable services that were actually performed, for less than $6million, so the cases are nothing alike even if the allegations were true.

May 8, 12:03 am | [comment link]
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