FBI 'cracks $50m healthcare scam'

[Daktoria]

http://news.bbc.co.uk/2/hi/americas/8117991.stm
The FBI says it has uncovered a $50m (£30m) scam involving the US healthcare system, making arrests in Florida, Michigan and Colorado.
Fifty-three people have been charged with defrauding Medicare, the government insurance scheme providing care to the elderly and disabled.
Doctors allegedly gave cash to patients to sign paperwork claiming to have had treatments which they were never given.
Medical staff, patients and company executives are among those charged.
A day earlier, police arrested eight people in Miami involved in a separate scheme using fake clinics to generate fraudulent bills of around $100m.
Federal agents say they are investigating almost 2,500 other cases and that fraud is costing American taxpayers billions of dollars every year.
Those in the administration and Congress now working on wider healthcare reforms say building better safeguards will be central to any new system.
President Barack Obama is currently seeking to overhaul the US healthcare system.
Gotta love governmental health care, the only thing that could have been better in this case IMO is if the scammers didn't get caught. Politics ruins all industries by excusing criminals for just being politically correct, and if these guys got away with what they were doing, it would have only continued to teach the American public this hard lesson.

[Lily]

It's not just large rings of criminals doing this. Case in point: Last night in my ER, a patient asked if the PA would write the scripts in his wife's name because, "She's on Medicaid and I'm not."

When I told he we couldn't do that, he asked why. "Because it's fraud," I said. "And you, your wife and the PA could go to jail for Medicaid fraud."

He laughed. "Oh," he said, "I know people that do it all the time."

Okay.

Apparently in his community, the folks lend their Medicaid cards out to others, go into ERs with complaints that belong to other family members/friends to get scripts, and routinely ask physicians to write scripts in another family member's name.

I wondered how this was possible? So, I asked one of the registration people, "If someone comes in with a Medicaid card, do you ask for ID?" Yes, they said. "And if they don't have an ID?" Well, we just take thier word for it if they have the right birthdate or social security number.

Okay.

Seems to me the Obama administration needs to look into ways of curbing this kind of fraud, pronto.

[Daktoria]

Federal reform could have some problems since the most effective tactic would be locally holding clinics and hospitals directly accountable for fraud. Not only would the claimer be penalized, but so would the health care provider.

Unfortunately, there's clear hesitation involved since medical practitioners are dedicated to taking care of people and don't want to see patients go without care. Likewise, bureaucratic administrators don't want to be ousted for turning away clients.

Then and again, decentralized and privatized health care wouldn't have this problem since politics wouldn't get in the middle of it all. If someone abused the system, a civil lawsuit would be filed and the con artists would be sued directly....

...but again, we're talking about poor and disabled individuals who don't have much to sue for anyway, so the only way this could be enforced is if the individuals were forced to play by the rules or be refused treatment altogether, something that medical practitioners and nurturing citizens don't want to see happen.

It's not going to be nice, but ultimately, tough love is the only solid answer over the long run, and as long as we keep passing the buck onto the next guy to get taken care of in order to avoid awkwardness, it's never going to get done. Hence why grassroots reform is the way to go, not more federal red tape.

[Michael]

With all due respect, $50 million is a fairly small scam, give the size and scale of Medicare billions.

My only point is for perspective here. Yes the government makes a nice easy target for such fraud, but it is to be noted that the private sector fraud/scams recently exposed (Madhof and Sanford for example) dwarf this sum by several orders of magnitude.

(I suspect this story will get heavy coverage in the attempt to use it to discredit the idea of public healthcare during a political debate about public healthcare)

[Daktoria]

With all due respect, $50 million is a fairly small scam, give the size and scale of Medicare billions.

My only point is for perspective here. Yes the government makes a nice easy target for such fraud, but it is to be noted that the private sector fraud/scams recently exposed (Madhof and Sanford for example) dwarf this sum by several orders of magnitude.

(I suspect this story will get heavy coverage in the attempt to use it to discredit the idea of public healthcare during a political debate about public healthcare)

Certainly, but those scams aren't something that the government (as a benefactor) was directly a victim of despite how the SEC should have done a better job making sure that consumer sovereignty wasn't violated (consumers being those who purchased "portfolio management services" as misleading as that phrase might sound). Something such as banks scamming the FDIC out of account insurance funding would be a comparable event.

Speaking of coverage though, did you watch Obama's town hall interview on ABC (http://abcnews.go.com/Politics/HealthCare/story?id=7919991&page=1) last night?

[Birdzeye]

I somehow doubt that Medicare and Medicaid are the only health care programs that get targeted for fraud. Every time I get a claim statement from my health plan, it always comes with a not to call a certain 800 number to report fraud. It looks like they worry about being targeted as well.