In my role as a healthcare industry ethics motivational speaker, healthcare ethics consultant and book author, the recent findings by the Justice Department and the subsequent convictions are disturbing – but not unexpected.
In the latest series of fraud arrests in the healthcare industry, a national network was brought to justice with incredibly staggering numbers. The overall valuation of the illegal activities amounted to more than $2.5 Billion. The cases of tele-fraud involved 78 defendants and included 24 physicians, therapists and nurses. If you are looking for great moments in the history of the guardians of the Hippocratic Oath, this ain’t it.
According to the DOJ and as summarized by legal writer Dave Malyon (MSN, June 29, 2023):
“The enforcement operation, which lasted two weeks, spanned 16 states, including California, Florida, Georgia, and New York…as a result of the action, 90 Medicare and Medicaid revocations and billing suspensions were issued and significant amounts of cash, automobiles, and real estate were seized or restrained.”
Using tech to commit fraud
The main schemes targeted, as they often do, the most helpless of society; those with addictions, impoverished single moms, the elderly, mental health problems and HIV/AIDS patients. According to Malyon:
“In one case, the alleged leaders of a software company conspired to create a platform that facilitated the sale of unnecessary medical equipment in exchange for kickbacks.”
The organization developed what had been a vast telemarketing scam complete with legitimate looking advertising to persuade the vulnerable to apply for expensive medical devices that they did not need. The software was so sophisticated it created phony Medicare forms. In this way, unethical physicians who were part of the fraud signed the fake documents and submitted them to the government.
This fraud alone, using phony sales reps, generated close to $2 billion. Another case that was detailed involved a Washington-state physician:
“Of signing over 2,800 fraudulent orders for orthotic braces, including for patients who had already undergone limb amputations.”
As a healthcare industry ethics motivational speaker, healthcare ethics consultant and book author, it is impossible to not feel sad about what happened to vulnerable patients on an individual basis.
The DOJ said all the right things when the arrests were announced:
“The Justice Department’s intensified efforts to combat fraud and bring criminals to justice …we will find and prosecute those who seek to defraud Americans and steal from taxpayer-funded programs.”
The words are nice
The words are nice, and as a healthcare ethics speaker and consultant, I suppose they offer a sort of comfort to those who haven’t been fleeced and those in the media who shake their heads.
However, my take is not as forgiving or accepting. The main fraud that raked in billions, took a concerted effort on the part of many individuals. There is no single culprit. It took software developers, crooked telemarketers, shady advertisers and, of course, healthcare “professionals” who forsake every standard they purported to represent. Even the scam run by the physician’s office in Washington state was an intentional racket backed by someone who claimed to heal and not harm.
Words are nice but, the missing element in the billions, if not trillions of dollars of Medicare fraud are “ethics.” Ethical behavior is not being taught, not being reinforced and not being celebrated. That a physician or RN would become involved in such scams is frightening. No, I am not naïve to the ways of the world, only how easy it has apparently become to deceive the system and to capitalize on the system.
Not surprising, the money that poured into the offices of these scam artists did not go for altruistic causes, but for lavish homes, luxury cars, expensive vacations and such. At its source, was the rationalization applied to making these decisions. The government continues to be seen as an open piggy-bank.
The ethical response to the government is that while it’s impressive “you” want to bring people to justice, it would be even more impressive if “you” would not make it so damned easy. It starts with ethics, ethical training and reinforcement. It must reach down to every examiner, and on the other side, into every medical and nursing school.
How many legitimate patients, I wonder, could have been helped while this magnitude of fraud was making unethical people rich?
LEAVE YOUR COMMENTS
