Examples of Medicare Fraud — 3

12/10/1981 (cont.): “Dr. XXX, who is awaiting sentencing on a September fraud conviction, told the senators he had filed Medicare forms that were ‘arrogant and outrageous’ in their falsity but had nevertheless received $500,000 in Government payments for more than $1.5 million in services he claimed but never performed. ‘I was astounded when some of those payments were made,’ he said.”

By the way, I am not cherry-picking these reports. In these early days, there were not that many, and I am presenting nearly all. Quite soon, however, the reports mushroom.

11/5/1983: “According to the F.B.I., the 42- year-old neurosurgeon billed Medicare $75,000 for services that he did not perform, including ‘dozens of spinal surgeries,’ between November 1981 and May 1983.”

3/13/1984: “…a Prince George’s County nursing home owner was convicted here today on six counts of Medicaid fraud stemming from work done on his private medical office, residences, beach house and a daughter’s condominium, all at the nursing home’s expense.”

12/2/1984: “More than 300 doctors and medical suppliers were kicked out of the Medicare and Medicaid programs because of fraudulent claims during the fiscal year ending Sept. 30, the Department of Health and Human Services said yesterday.

“The figure is a 29-percent increase over the 230 health-care providers barred during 1983.

“The frauds included billing the government for goods or services not provided or for services that did not qualify for reimbursement, or for overcharging.”

“Margaret M. Heckler, the secretary of health and human services, said in releasing the report that it showed the department’s commitment to using its budget ‘for caring and compassion, not for corruption, waste, or inefficiency. There is no letup in this department’s quest for cost-effectiveness, and there is no slacking in our attack on waste, fraud, and abuse,’ she said.”

No matter how committed  HHS is to attacking fraud, my main point in these blogs is that it is incapable of reducing it without incurring much higher costs of monitoring and enforcing the statutes. And if they did enforce them, they’d create another negative. They’d rope in many doctors and hospitals that fudge the numbers and paperwork in order to get around Medicare regulations that interfere with good medical practice.

3/10/1985: “Ten private ambulance firms in New Jersey are under investigation for Medicare fraud, and at least four of them are reported likely to be indicted as part of a federal crackdown…”

6/3/1985: “Twenty-one Texas hospitals have filed billions of dollars’ worth of false Medicare claims in a scandal the General Accounting Office says rivals defense-contract overcharges, a newspaper reported yesterday.

“‘With General Dynamics, we were talking millions of dollars,’ said Dan Garcia, a senior evaluator in the GAO’s Dallas office. ‘Here we’re talking billions.'”

2/26/1986: “A medical ethics board voted Wednesday to revoke the license of a cardiologist convicted of taking kickbacks from pacemaker companies and accused of implanting the devices in dozens of healthy patients, a source said.”

I’ve run across several reports from Australia about similar issues in its Medicare program:

11/18/1986: ”

CANBERRA: Many serious cases of social security fraud are not being investigated, according to the Director of Public Prosecutions.

As well, the Government’s health insurance legislation is too weak to successfully attack Medicare fraud.”

2/6/1987: “The operator of medical-testing labs, who the government contends is involved in massive Medicare fraud, was found guilty Thursday in two kickback schemes.”

Every facet of the medical sector that is involved with Medicare has its frauds: doctors, hospitals, nursing homes, manufacturers of medical equipment, ambulances, laboratories, etc.

 

 

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2:30 pm on October 26, 2012