Uncovering Medicare Fraud, over $700 million in fraud in recent cases.


This video is very important.  It talks about how the DOJ and HHS have a joint initiative strike force to eliminate Medicare fraud and the joint initiative has been very effective.

Healthcare fraud is “distressingly common”.  Despite the fact doctors make very good money, they participate in incredible schemes to defraud health care.  The new Obama Care act gives state agencies the tools they need to uncover fraud and return the stolen money.

In Miami recently dozens of defendants were involved in $263 million in false medicare claims. There were reports of ripoffs from hospices to hospitals.  In one case involving $74 million in thefts, certain companies and doctors where shuffling around hundreds of dementia patients and saying they were providing intensive psychotherapy, but in fact these were services that never happened.

In one of the single largest cases in Miami, doctors and administrators were participating in schemes to “upcode” patients, meaning, expensive services were billed, such as CT scans, etc., when in fact the patient only had a cold or sore throat. Of course, the expensive service was never performed.

Another common scheme was to bill for expensive equipment, but never actually get it.  For examply, say 100 expensive specialized wheelchairs are billed to medicare but they never appear, or if they do, they are sold to other places.

And all the while, there are in fact elderly, sick patients, often with dementia, that are in need of services they just don’t get, and all the doctors and medical administrators see are the elderly as ATM machines printing money for thieves.

One recent wheel chair scam in Los Angeles involved $123 million in phantom equipment, including 1,000 expensive wheelchairs

The problem turns out to be nationwide.

$15 billion has been recovered in 7 years related healthcare fraud in medicare making the program a winner.  This joint DOJ/HHS program is very successful, because for every dollar spent on this program $8 are returned making it an 800% ROI.

$50 billion in 5 years has been returned to DOJ.

Many claims have come from false claims act (qui tam) where whistle blowers were very helpful to stop these criminals.  However, these whistleblowers face huge retaliation from their employers and others part of the schemes. There are countless stories of the terror these whistleblowers were put through for merely reporting the crimes they saw committed by major hospital companies and doctors.

I am glad there is hope that the HHS and DOJ are stopping the treatment of elders as walking ATM’s for dispensing millions to the criminals attracted to health care where previously anything goes.


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