When a friend forwarded this widely circulated CNN-Money news article the other day, I thanked him for his kindness but told him, “Oh I’ve already seen it.” I owe my friend an apology; it was new information and a whole new set of fraudulent charges and rotten ethics.
Medicare Fraud
The article, by Katie Lobosco, entitled: “Doctors and nurses busted for $712 million Medicare fraud,” states:
“The FBI arrested 46 doctors and nurses across the country this week in the largest Medicare fraud bust ever. In total, 243 people were arrested in 17 cities for allegedly billing Medicare for $712 million worth of patient care that was never given or unnecessary.”
The cases included all sorts of unethical nonsense including fictitious mental health billings in the tens of millions of dollars; a company shipping glucose monitors to thousands of patients who didn’t want them – to the tune of $22 million in fraudulent charges; a physician in Los Angeles billing Medicare $23 million for 1,000 power wheelchairs and a healthcare provider receiving $1.6 million for prescription drugs that were never purchased and never given to patients.
States the article:
“In some cases health care providers paid kickbacks to fraudsters who could get their hands on Medicare patients’ personal information. They would then use that info to bill Medicare for bogus care…Sometimes fraudsters, known to the Feds as ‘patient recruiters,’ will go to places like homeless shelters and soup kitchens and offer money to those who would share their Medicare patient numbers.”
The article concludes by telling us that the DOJ’s Medicare Fraud Strike Force has uncovered $7 billion in fraud since 2007.
Who are we talking about?
We are, of course, talking about medical professionals; men and women who are presumably trained in the ways of healthcare, medicine, the Hippocratic Oath and all of that rot.
However, it is not so much the individual fraudsters, but an entire infrastructure of deceit that has apparently been allowed to transpire. How does it happen for example, that a physician can bill Medicare for 1,000 wheelchairs at the incredible price of $23,000 a piece? Is the system so unethically corrupt that mistakes of this type are usually not caught? In addition, who within the vast bureaucracy of Medicare would allow the agency to even allow one wheelchair to be billed at that price?
I am the first to admit that I am not an expert on power wheelchairs, but after reviewing all makes and models on Amazon.com just now, the most expensive, bells and whistles, power wheelchair I could find still came to under $4500.
We in this country can still agree on one thing: the healthcare system is really not working for anyone. Everyone either has a horror-story of their own, or they know of someone who has been royally screwed over by the system. There is one minor exception: members of congress have a real sweet healthcare plan and everyone knows it; maybe that is why nothing is getting done.
The issue of Medicare fraud is one that shows no sign of going away. I have little doubt that in a few months another friend will sent me yet another article detailing another set of fraudulent claims. It occurs to me that the one approach that has not been tried is the ethical approach.
The system must be willing to embrace an ethical solution to this problem, with ethical expectations and an unwavering response to fraud.
What does it take?
How many $23,000 wheelchairs does it take to alert someone sitting at a metal desk in Medicare headquarters that something is amiss? That is the point at which I would start. I would begin by “charging” everyone within the vast bureaucracy to take ethics training and encourage them to more aggressively pursue cases of suspected fraud. One-thousand wheelchairs at $23 million is pretty serious stuff; so is one chair at $23,000.
For physicians or RN’s who engage in fraud, I would honestly pursue the only avenue that I believe would truly scare them – pull their licensing. The physician who pocketed the $23 million for wheelchairs does not deserve his/her license, nor does the psychiatrist who billed tens of millions of dollars for moving patients around rather than treating them. Ethical training must start in medical school, with the trainer making it crystal clear as to what happens when an act of Medicare fraud is committed.
Stopping Medicare fraud also begins with each one of us. Granted, the DOJ uncovered $7 billion in fraud since 2007, but my guess is that the actual number may be many multiples of that number. As patients, we are stronger than we think. How many of us know of cases (even for ourselves) when billings have seemed absolutely over the top? How did we complain? Were we simply content to let someone else pay for it?
Ultimately, we are all responsible for fraud of this nature. It is past time to take the system back.
