I am always amazed by the amount of Medicare Fraud that continues to happen every year. Every time the Feds have a large bust, they say it is the largest fraud ever. In 2010, we have had four of the "Largest Medicare Fraud ever!" headlines.
March 2010 - "The largest Medicare fraud ever in the nursing home industry"
Medicare fraud by California-based nursing home company North American Health Care (NAHC), which operates 35 nursing homes in four states. NAHC may be falsifying patient records and overcharging Medicare by tens of millions of dollars each year. Indeed, a number of former NAHC employees have testified to repeated orders to alter and falsify patient records. NAHC appears to be an industry leader in "upcoding" services provided to Medicare patients and charging Medicare the highest possible rates for resident care.
July 2010 - "Brooklyn Arrests Are Part of "Largest Medicare Fraud Bust Ever"
The FBI has arrested three doctors and doctors "professional patients" in Brooklyn for allegedly submitting thousands of bogus medical claims to Medicare and Medicaid. Prosecutors said the doctors and their clinics stole more than $80 million from taxpayers. The local arrests are part of the largest Medicare fraud bust ever. Dozens of suspects accused in scams totaling $251 million were busted in five states, authorities said. In one Brooklyn office, the doctors had set up a "cash kickback room" to pay patients for allowing them to submit false bills to the government health programs. The so-called "kickback" room had a poster on the wall resembling Soviet-era propaganda, showing a woman with a finger to her lips and two messages in Russian: "Don't Gossip" and "Be on the lookout: In these days, the walls talk."
October 13, 2010 - "44 Charged in Huge Medicare Fraud Scheme" An Armenian-American crime syndicate stole the identities of doctors and thousands of patients and used them and more than a hundred spurious clinics in 25 states to bill Medicare for more than $100 million for treatments no doctor ever performed and no patient ever received, the federal authorities announced on Wednesday.
October 21, 2010 - 4 arrested in alleged $200 million Medicare fraud case
Federal agents arrested four Miami-Dade health care operators Thursday in one of the nation's biggest Medicare fraud cases, charging them with scheming to fleece $200 million from the taxpayer-funded program by billing for bogus mental health services. Lawrence S. Duran, 48, of North Miami, and his company, American Therapeutic Corp., were charged along with other employees in a conspiracy indictment. The Miami-based company's chief executive officer, Marianella Valera, 39, was also among the defendants named in the indictment.
This fraud has been going on for years. The good news is, the Obama Administration is catching up to them and filing charges against them. Additionally, for decades, Medicare and its contractors have relied upon a largely antiquated policy of reimbursing health care claims quickly without verifying them. The brisk payments, typically made within 14 days, keep the healthcare system going but also fuel corruption.
In September, President Barack Obama signed an anti-fraud law that will require the behemoth Medicare bureaucracy to act more like a credit card company in flagging suspicious claims that could save taxpayers billions of dollars a year in wasteful government healthcare spending. The anti-fraud provision, tucked into the Small Business Lending Act, will force Medicare and its claims contractors to adopt new billing software with "predictive modeling" for the 10 worst states by next year.
No wonder many in the Healthcare Industry, including Doctors, want to make sure President Obama does not win re-election in 2012.