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Medicare fraud: outrageous

Posted: Monday, December 10, 2007 11:50 AM by Barbara Raab

By Mark Potter, NBC News correspondent

If you've been around long enough, you find yourself bragging that "nothing shocks me any more." I say that a lot, and often it's true. But then I started looking into Medicare fraud, and was I shocked! Floored, actually. Medicare fraud is an outrageous pilferage of your and my money--an estimated $60 billion dollar-a-year theft. Until I looked closer, I had no idea just how widespread it is, and how brazenly an army of criminals has turned America's social safety net for 43 million seniors and the disabled into its personal bank account.

In reporting this week's two-part series on Medicare fraud for Nightly News (watch a preview here), I rode with a private investigator, and later went with some FBI agents as they checked on storefront operations that purport to be legitimate medical supply companies. In most cases, they are actually just "fronts" or shell-companies designed only to bilk Medicare. They have nothing to do with actual health care.

In one building alone, I saw nearly 30 offices with signs saying they were either medical supply companies or medical billing companies. Most of the doors, however, were locked, with no indications anywhere of legitimate business. I saw the same thing in other buildings, and in shopping centers--row after row of supposed medical companies that, according to federal authorities, are billing Medicare for millions of dollars each, for services never rendered, for patients never served. The main function of these offices is to fool Medicare inspectors, who rarely visit.

In the next two evenings on our air you'll see some shocking things: a multi-million dollar wheelchair (at least that's how it was billed) and patients being paid cash to cooperate in a fraud scheme.

You'll also meet some interesting people, including Miami's retired Chief Federal Judge Edward Davis, who learned that criminals had stolen his patient ID number and billed Medicare for something that he described as "outrageous"--that same word again. We'll show you what it was. And you'll also hear from a one-time Medicare thief who stole millions and now says it was way too easy.

A while back, Michael Leavitt, the U.S. Secretary for Housing and Human Services, was taken on the same fraud tour in the Miami area that I took. And his reaction was exactly the same. When he got home that night, he told his wife, "In a decade and a half of public service this was the most disheartening, disgusting day I have ever spent. We have to fix this!"

There are a lot of ideas on how to do that, and we'll share some of those thoughts, too. Perhaps 82-year-old Muriel Sherman, whose Medicare patient number was stolen and abused for years, has the best rallying cry: "For these people to do this and not be apprehended is an absolute insult to me, and everyone else." Fix it, indeed.

Editor's Note: Mark Potter's report airs tonight on the broadcast.

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Comments

While unfortunately there is fraud in the Home Medical Equipment Insustry, there are many that are honest and have many hard working employees improving the quality of lives of thousands in the comfort on their own home in a cost effective manner when compared to hospitalizations or institutionalized care. Would like to see fair and balanced coverage.

The government must assume some of the responsibility for giving access by allowing "criminals" to set these companies up and bill fraudulently for millions of dollars most of which have left our country before discovery has occurred.
The facts are society is aging and the need for home care services will continue to grow. Let's make sure that legitimate companies are not lumped in with the bad guys so we can be here to serve those in need in the coming years.
GOVERNMENT DOES NOT KNOW HOW TO POLICE IT'S SPENDING
POLICIES. WHEN THEY TRY TO CURB FRAUD, THEY TAKE SIMPLISTIC APPROACHES THAT DO NOT WORK.  NOW THEY ARE TRYING TO HAVE ACCREDITING AGENCY DO THE WORK THEY SHOULD BE DOING.  MEDICARE POLICIES PER ACCREDITATION AND SUPPORTING MEDICAL NEEDS RESTRICTIONS ARE AMBIGIOUS.  THESE POLICIES SHOULD BE WRITTEN IS TERMS THAT GIVE THE PROVIDERS A CLEAR UNDERSTANDING OF WHAT IS REQUIRED.
Guilt by association has always been a troublesome issue in this industry.  The government employees have done a very poor job to eliminate the fraud in the DME industry.  For example, the news reporters were highlighting the Medicare fraud in Houston (now known as Operation Wheeler Dealer) 12 months prior to the government agencies investigating.

As a 20+ year industry employee and former JCAHO surveyor, I can assure you that fraud does exist and must be ferreted out by the fraud investigators - many of the companies should not be included - they go above board to assist patients that hospitals won't.
Mark these crimes are happening because no one watching the store. Remember the open bank policy by the Bush Administration. Seniors have horror stories and the only time the GOP came to talk is when they needed their vote and the scam for the drug companies. Soon I'll be on medicare and I know I'll be hosed if my kids don't help me with the sharks if a Republican gets in office.  I was lucky to be on a web call something like that, where I got to speak to Hillary about her Health Care plan.  I was feeling much better with her answers and plans.  I did read about Senator Obama and Edward's plan but wasn't impressed with it.  The way I see it is if we can give out Trillions of dollars to Iraq for nothing in return we should have on problem with American Health Care.  I did notice how great the Law Makers Health Care Plan is.  Also much people don't think about these things until they need it, like most of the reporters brush it off but there will come a day when they to will be asking where's my tax dollars going for all the years I've paid.
There's also a huge will NOT to know on the part of the Centers for Medicare and Medicaid Services.

For a long time after my grandmother died, she received EOBs purporting to have dispensed Orthotics and so on to her.

I called the medicare frauds people and they couldn't care less.  Even though I explained that my grandmother was dead at the purported time of service and the claims were therefore obviously fraudulent, they told me they can't take a complaint from me.  It had to come from her and be signed and notarized.  

Translation, medicare knew all about the fraud, but had no interest whatsoever in cleaning it up, because that would involve extra work on their part.
This is why we need LESS, not more, government social programs and entitlements.  If you think this is bad, just imagine the thievery that will occur if a national healthcare program is implemented....
It’s a real shame, but the fact of the matter is that there are and always will be unscrupulous people. I would hate for people to denigrate an entire service industry because of those few. The real problem is Medicare’s non or slow enforcement of it’s own rules thereby allowing these people to take advantage of the system.  Rather than enforcing rules that are already in place and thereby saving Billions in fraud, Medicare and Congress are spending Millions to create new rules that aren’t going to be enforced either. The legitimate business people will be suffocated under the burden of compliance, patients will suffer, services will be cut off or denied by strapped providers and the crooks will continue to ignore the rules and soon only the crooks will be left.  
The only law that has been effective against Medicare fraud (and all types of fraud against the government) is the False Claims Act. Employees who know that their employees are committing fraud against the American taxpayers can file a secret claim with the Justice Department (or their state AG, if a state statute applies) describing the fraud, and later be rewarded 15-30% of the money recovered for the government.

The law is good at ferreting out fraud, and lucrative for an honest whistleblower who will no doubt face some harsh retaliation for trying to do the right thing, but it is a difficult law to navigate. Learn more about the False Claims Act at the Whistleblower Protection Blog -- http://www.whistleblowersblog.org

It is interesting to me how many news stories come out over this topic and supposedly how many arrests are made, but exactly how much is recovered? The guy with the Rolls Royce is God knows where with our Medicare dollars. The truth is that the job of policing these things (such as moving from one location to another)are sub-contracted to companies that do not do their job and they are not held accountable. They do not have to refund what they got paid or do not go to jail for fraud. How hard is it for the computers for Mcare part A and B to speak to each other so that no prosthetic is paid unless there is documentation from a physician or a hospital that something removed was billed. We can put a missle thru the terrorist house from anywhere but we cannot get our computers to talk. Why don't we MAKE THIS A CAMPAIGN ISSUE!! WHY NOT? BECAUSE IT IS MILLIONS INSTEAD OF BILLIONS? ALSO HAVE YOU EVER TRIED TO REPORT A CASE AND AFTER YOU ARE ON THE PHONE WITH MEDICARE FOR 2 hours with YOUR RELATIVE YOU'RE NOT EVEN GIVEN A CASE NUMBER AND THE NEXT MONTHS FOLLOWING THEY PAY IT AGAIN!! STOP THE INSANITY MAKE OUR GOVERNMENT MORE RESPONSIBLE! WHY DON'T WE REPORT THAT????????
I used to be in the medical supply business - and got out because I knew that legitimate companies were an easy target for overzealous investigators - and that the bad guys would ruin the industry, but for the most part, get away with it. People in the industry know who the frauds are, but they are also afraid for the Government.
As long as administration (past or present) is PENNY WISE AND POUND FOOLISH by cutting operating budgets for various departments such frauds will continue.
Medicare fraud is rampant in all states.  You should also look into Social Security.  In Indiana, there seems to be a practice at local offices of taking a fee of several thousand dollars. This comes out of settlements for disabilities. If an applicant wins their appeal the local office takes a handling /user fee from the settlement before disbursing the remainder to the client.
 Why would anyone pay a bill without knowing who it is from? who approves these payments? This is not something new it has happened in every goverment program, you, me and everyone else knows it, yet it goe's on.
Medicare fraud, in the Miami area, made the news more than 15 years ago....same old stuff, and nothing done about it.  Medicare continues to issue medicare billing authorizations without checking, in person, to see if the company requesting it is legitimate, or in fact, if it exists at all.  They have issued these permits to PO Boxes, to non-existent af=ddresses, etc. etc.  If they hired investigators to check the things out, before they send them money, they would save enough to pay the inspectors salaries manyfold.  Better look at what is happening within the system, and get on their tails.  
Yeah it must be Bush's fault. Couldn't have anything to do with worthless union protected democrat slugs who bleed this country dry by pushing paperwork from one side of a desk to the other.
Five years ago I tried to get the media interested in this type of story. About 9 months after my mother died, I discovered - after carefully reading the EOBs - that Medicare had paid for an $8,000 wheelchair that she had "tried out" unsuccessfully for 2 weeks at her assisted living facility. I had thought it had only been rented.  When I called the assisted living facility to find out where the wheelchair was, no one returned my call until I lied and said that Medicare was asking me to account for it and if I couldn't, Medicare would be calling the facility directly. Of course, that call was immediately returned. I was told that the vendor had been "storing" the wheelchair for the past 9 months and would be happy to release it to me.  Since I lived in Pennsylvania and the chair was in West Palm Beach, Florida, I tried to find a place to donate the chair to in the West Palm Beach area.  No one would take it because - owing to liability reasons - they said they could only take new chairs. I assured them that I was positive that the chair was brand-new - that at the very most it had been used for two weeks.  (I was pretty convinced that the vendor had already resold my mother's chair.)  I ended up finding an organization that arranged for wheelchair donations in Eastern Europe. Who knows if it was a  "kosher" organization - all I know was that I didn't want the vender to keep the chair and resell it over and over again.

I called Medicare to report this and asked them to investigate. I was asked if I had any proof.  I was also asked how I would feel if someone falsely accused me of doing something illegal. THey refused to investigate.

Another issue with Medicare: A year after my mother died, her forwarding address from Florida expired. I called Medicare to give them my address so I could continue to review the EOBs.  Medicare told me that they couldn't change anything because my mother was dead. I told them that EOBs were still being sent and I asked whether they cared if someone was reviewing them the make sure everything was in order - perhaps to help save Medicare money. Again I was told that my mother was dead and none of her data could be changed.

What we need in this country is LESS Government!  Can you really imagine this stuff happening all the time in the private sector?  It is WAY beyond time that we hold these incompetant Government agencies accountable.  I am sick of my hard earned tax dollars going to thieves, and no one doing anything about it.  I think we need to get rid of the Government and their bloated ways, and privitize!!
Where can I sign up to take part in the Medicare fraud? I have a $30K a year job and a $105K graduate loan which costs me $501 a month. I'm 48 years old and I'll be paying my loans back well past 70! I figure the government has screwed me, I might as well get my piece of the pie.
Pick any government program and you will find poor accountability of how tax dollars are spent. We can't account for billions in weapons transferred to Iraq.  CMS issued these companies a Medicare provider number and their contractors are required to verify the business exist with posted hours, inventory and staff. Did this ever get done?   Every owner and beneficiary needs to be aware and report unscrupulous doctors, check EOB's for not requested equipment/ medication. CMS strategy is throw the spotlight on " others " to avoid their own poor management of accountability.
 I am disabled and have called Medicare about inflated bills from doctor visits and was told that they, (Medicare), pays whatever is billed to them, even if it is obvious to them it is way too much for a particular service. This particular doctor was billing an office visit for $250, but if you walked in without medicare the visit was $40.
 
I've called about tests that were not performed but billed and Medicare said they pay without question, it didn't matter if I had the test or not, if they were billed they paid.

No wonder Medicare is in trouble.
Medicare fraud is bad enough, but my husband has been trying for several months to get someone...anyone, to listen to him.  He is being paid $33.00 per month TOO MUCH on is social security check.   When he signed up for S.S. in July at the age of 68, he was told his Medicare premiums would be higher than others because he was to pay a penalty for not signing up for Medicare at age 65.  However, the additional premium has never been deducted from his monthly check.   We have called Social Security and  Medicare and followed up with letters.  We have had no response.  We are honest citizens trying to give money back to the government, but our voices are not being heard.  And don't you just know that somewhere down the road the powers that be will come looking for our ill-gotten gain???
I am the owner of a Home Medical Equipment company in Miami, Florida serving pediatric, mostly indigent or lower income Medicaid clients for 17 years. I could not agree with you more that fraud in our community is rampant and could be easily detected and prevented by government agencies. Our company itself has been a victim of this fraud, dispensing expensive power wheelchairs to clients only to be denied payment because a fraudulent company had already billed Medicare for a wheelchair for the same client that was never ordered or delivered.
However, it would not only be fair, but it is your moral obligation to point out in your reporting that the home medical equipment industry was created and still largely functions not only to cut health care costs dramatically by reducing the number of hospitalization days but  to also enable people suffering from chronic illness to enjoy as high a quality of life as is possible while remaining at home.
I and all of my employees share a special pride in the service that we provide to our patients. We have developed strong relationships with  them not only by providing much needed equipment, supplies and training but often by providing emotional and psychological support as well.  I know that, given the opportunity, our patients would testify to the vital and essential role that our company plays in their lives.
We have continued to provide these services without compromise for 17 years in spite of continuously decreasing reimbursements and ever increasing costs and scrutiny by government agencies.
We invite you to visit our place of business, meet our pediatric clients and their families, listen to their impression of our industry and the impact our company has had on their lives and then write a story that will give an accurate picture of both sides of an industry that has been so maligned.

As a manufacturer selling into this industry, I can tell you that the overwhelming majority of Medicare service providers are legitimate, hard working small business people who help our senior citizens and the disabled every single day. CMS is structured in a way that allows these fraudulent bad actors to thrive. The dark side of human nature makes it a certainty that lucrative loopholes will be exploited everywhere, in every industry, everytime. This story should be an indictment on the "system" and what it hasn't done to address these loopholes not on the DME providers as a group.
I wonder how many fraud investigators $60 billion dollars would buy.  If they worked on a piece work basis we could just scoop up the trash once a week and be done with it.
I have a hard time beleiving all of that, I'm a medicare provider, my wife and I own an X-ray company, and so far medicare has stolen about $100.000 dollars from us, and there is nobody that we can complain, because nobody listens, right now they owe us about $30.000 dollars and we are getting about $100.00 every two weeks, I had to refinance my house twice, and borrowed $20.000 dollars just to keep the business going. why don't you report on the medicare abuses as well. thanks
As a physical therapist and owner of a medical facility in South Florida, I have heard from many patients the scams and outrageous rip offs from South Florida doctors, companies, and medical equipment places.  I had a patient who was charged by the local hospital for gynecological services when he was a man!  They ran up a $60,000 bill just for staying in the hospital without any special procedure or tests.  They complained to Medicare and the fraud department.  The Medicare person told them to just "forget about it" and "it happens all the time".  
The problem lies with the policing of the system.  Don't throw money at generating a bigger Medicare red taped bureaucracy !  Make the system more efficient by punishing those who commit these crimes and get rid of them.
In the physical therapy profession, Medicare patients are punished by having a limit on the care they can receive.  A Medicare patient will only be allowed $1,800 dollars for the year for physical therapy no matter what their problem is.  They could have a spinal cord injury, Parkinson's disease, or a stroke, but it doesn't matter, because that will be the Medicare rule.  This will go into effect next year.  It is the patient who suffers because, a person with a stroke will only have around 17 visits a year when they will need at least 40-50.  
In addition, our physical therapy practice has received a 20% cut in payments when our costs of providing service have doubled in 5 years.  We struggle to pay our bills and pay our therapists a decent salary for helping people.  It is the legitimate businesses like ours that get punished by a blanket Medicare payment cut!
Policy must be set by those in charge both in the political realm and at the Medicare CEO level.  Let's get something done now, before it is too late!
This is only one example of Medicare fraud. What about the millions of people fraudently collecting both Social Security disability as well as Medicare under the guise of mental illness - bipolar, PTSD, etc.  Most are active drug users who have latched on to the system and the lack of checks and balances/second opinions and in effect are having the feds fund their drug abuse.  What do you think a drug addict is going to do with a 3k disability check each month? Sleep all day , party all night, not a bad racket!
Even "legitimate" clinics work the system.

Go see your regular doctor for a complaint.

Then go to a clinic that takes medicare and count how many more trips it takes to resolve the same issue.  They do it to keep their billing up.  There is nothing legitimate about the entire industry.

It's not just the money the scammers siphon, it's the quality of care that suffers with even "legitimate" clinics.

California throws even more money down this hole.
How about a story on what Medicare will pay for vs what it won't pay for?  Such as a more expensive option for treatment vs a less expensive and just as effective treatment.  Two years ago my mother needed a daily intraveneous antibiotic.  She was not sick enough to need to stay in the hospital and we were all just fine with that.  Medicare, however, would only pay for her treatment if she went to a nursing home (not really sick enough for that either), stayed in the hospital, or received the treatment on an outpatient basis--daily trips back to the hospital.  Medicare WOULD NOT pay for the least expensive option--a home nurse to come out to the house and give her the medicine.  They would also not pay for me--her daughter and a registered nurse--to give her the medicine at home.  Had to be one of the more expensive options or nothing at all.  Can you say "waste of money"?  Just who is minding the store anyway?  I guess since it isn't really their money they really don't seem to care how it is spent--well I do and I don't like seeing wasted!!  Thanks--Paula Thomas, Spokane WA  
Could there be any more clearer reason than this that our seniors should be more in control of their own healthcare dollars!  Health Savings Accounts are available to Medicare recipients and will limit spending in a way that government alone cannot.  Individuals can control how much money goes for their health care expenses, and at the same time leave little room for these criminals to leech off the system.  I am a physician who opted out of Medicare due to bureaucracy that these criminals have helped create, which is only adding to the expense of maintaining the program.
If it is YOUR MONEY, you will be more concerned about what happens to it...and less willing to participate in anything which could jeopardize it, including the  aiding and abetting of fraudulent billing.
I am extremly ill and have just qualified for social  security disbility this year. I have to wait 2 years before I can qualify for medicare A and B. I will have NO insurence and do not qualify for any state social service benefits because my  husband who also is disabled, and my disability is "too high" to recieve any benefits. No insurence company will insure me because I am on social security disability. I have worked years and I can't afford the Cobra insurence thru my last employer. It is as much as my disability payments. I will not be able to get my drugs or health care that I need. What a Wonderful Life! So much for helping the disabiled!
I'm not surprised at all at the rapid crime of fraud and abuse of Medicare but I was a little taken aback by the showing of the criminal's SSN on TV. Even though he's a criminal let's not purposely help more criminals with identity theft even if he does deserve it.
Our elected officials are obsesed with the people that blew up the trade center and allow the insurance system and doctors to take all of our money...... legally,   WTF........
This is sooo right.  I have ten years worth of experience working for a Medicare intermediary (a company that processes the claims).  I saw this every day, and it affects us all.  When Hillary states that she wants everyone to have health care comparable to Medicare, it makes me cringe.  How to fix it?  It would be great if there were some easy way to put a bandaid on it and cure the problem, but it would take a major overhaul to fix this.  Is it possible?  I don't see how, too many people benefit from it.  One more item that wasn't included in the article.  Even legitimate companies overcharge Medicare.  It's an easy way to increase profits.  When do we call it fraud?
Until the penalties match the crime there will be no diminution in this kind of activity. Like selling illegal drugs, the payoff is so much greater than the penalty that there is no deterrent. And as long as politicians continue to solicit and accept donations from these people the penalties will not be increased. Just look at how long it takes the candidates to reject or return donations even when their illicit nature is proven. The greed is in more places than just the pockets of these creeps! The current system was set up with the active participation and knowledge of our political leaders. Believe me, the bureaucrats know exactly what is wrong with it and what needs to be done to fix it but the pols will never allow that to happen; too costly to them! Here in NY for 30 years the attorney generals and comptrollers have been calling for tougher penalties for the same fraud in the Medicaid program, to no avail for the same 3 reasons -- money, money, money. What we need is much, much tougher penalties and lots more independent auditors and investigators (LOTS more) who can act on their findings without waiting for the pols to finish wringing their cash-grubbing hands.
I'm sorry, but Reagan used this type of yellow journalism story to scare people into believing that it was the poor that were to blame for all of the ills in this nation, and you sir, are little more than a perpetuator of that urban legend with this story. So, what is your point? The perpetrators ar the mainstream poor? Why don't you point to Halliburton's rape of America, Iraq, Kuwait, and other Middle Eastern countries? Doesn't fit in with your right wing agenda, eh?
Welcome to corporate America. There will be fraud wherever there is money to be made, so we can't blame the criminals - thats what they do. But how about holding the insurance companies accountable? We have more than enough evidence to prove that every single health insurance company in operation in the United States today is in business to make a profit from people's illness and worse, to deny authorisation for treatments wherever possible to keep more profit on their bottom line, which you are paying into, and always at the expense of your health and life. Yet the government doesn't think that denying patients treatment they are suposedly covered for is an issue that needs addressing??...How is that allowed? Probably because they are a few political back-pockets being lined with the right colour paper, no doubt.
The answer is NOT LESS governement programs, the answer is that health care should come out of your collective tax money, like in other civilised countries. If there is enough money to deploy soldiers to go kill people on the other side of the world, (for what reason again?? and lets not talk about how our good old war vets are treated for their efforts by their oh-so-caring government once they return home...) then there IS enough money to feed, educate and heal your own. American citizens need to wake up and join forces against the unmitigated bullshit that is dealt out to you every day by your very own government. As an outsider looking in on your supposed developed and "rich" nation, I am continually dismayed at how gulible and ignorant the average American is about what is being done to them, and in their name. Shame on you Americans for allowing it.
The other socialized medicine programs in other countries don't seem to have these problems. It does make one wonder about the moral fiber of some americans. I would say for various reasons and influences we are decaying from within. Time to bail out and enjoy our hard earned retirement savings before all of it is stolen from us. Canada, Costa Rica, Panama all sound pretty good. It'll be interesting to see how long it takes our government to act on this tragedy. Hopefully not as long as the immigration crisis is taking. I guess we could blame it all on Bush instead of looking at ourselves.
The other socialized medicine programs in other countries don't seem to have these problems. It does make one wonder about the moral fiber of some americans. I would say for various reasons and influences we are decaying from within. Time to bail out and enjoy our hard earned retirement savings before all of it is stolen from us. Canada, Costa Rica, Panama all sound pretty good. It'll be interesting to see how long it takes our government to act on this tragedy. Hopefully not as long as the immigration crisis is taking. I guess we could blame it all on Bush instead of looking at ourselves.
As a Cuban American I am totally disgusted with this criminal activity done by a lot of recently arrived Cubans who don't want to work honestly. These low life crooks should be deported back to Castro's disgusting communist paradise. A lot of these recent Cuban arrivals commit various forms of fraud on the island using the term "resolver" to "resolve". Once they come to this country, they take advantage of a lot of services and commit fraud not only in medicaid, but are also involved in automobile accidents fraud, causing car insurance to be so high here in Miami-Dade County. These people once convicted should be quickly deported. I don't care if they're Cubans. If they commit these crimes that give a bad name to decent honest work class Cubans; get rid of them and fast! These are  Castro's garbage. Garbage needs to be thrown out where it belongs!!!
THE MEDICARE BILLING DEPARTMENT, SHOULD NOT SEND CHECKS OUT TO THESE COMPANIES, FIRST WITHOUT SEEING THE THE PERSON AND ALSO ALONG WITH A CERTIFIED DOC. YOU HAVE A PRESIDENT OR CEO MAKING BIG MONEY RUNNING THIS COMPANY, MAKE HIM PUT OUT SOME MEMO'S THAT MAKE THESE COMPANYS SHOW HOW THE MONEY IS BEING APPLIED.    THE MAN    
I am a small legitimate Medicare provider and I was penalized by a Medicare contractor and lost my privilage file Medicare claims for 5 months but to a small clerical error which did not have anything to do with the filing of any claims.  This hurt my business dearly as the majority of my patients are elderly Medicare receipiants.  Being a small businees, it cost me dearly and I am getting out of the the business due to so much fraud and inconsistency.  It is small, legitamate companies who are affected to most.  I just wanted to provide good patient care and to make an honest living.  Not so in this industry.
  Well I suppose if we execute4d the perpertrators as they might in China it would slow them down a bit.

   The next best thing would be large and sure awards for whistleblowers under the Federal False Claims Act, or its equivalent under  Florida Law..
It is unfortunate that the crimes of a few overshadow the hard work of the many that are overlooked for SAVING the taxpayers MILLIONS by keeping millions of seniors and handicaped at home instead of paying for a lengthy hospital stay which would cost MUCH MUCH more to Medicare and Medicaid. How about doing a story on the Medical equipment providers who answer a beeper at 3 AM to fix a motor or deliver a replacement part so the patient can continue to breath their oxygen and live only to be told by Medicare in the next "breath" that they are cutting the amount they are paying you by 20 or 30 % and if you don't follow the mammoth paper trail they invented (Created to stop fraud....looks like Medicare dod a great job on that one) they are not going to give you a dime for that Oxygen. Another example of the honest THOUSANDS of small business men and women getting a bad wrap by the criminal few who make good headlines.
If you are a Physician, work as an x-ray tech or work in dietary for a hospital, outpatient surgery or nursing home. You cannot use a single dose vial of a contrasting agent on more than one patient. Regardless of how much is wasted; reimbursement for a proceedure is based on a whole unit of contrast for each patient. Contrast vials are only sterile for one piercing. If the same vial is used on more than one patient you are committing fraud.You can not sell any single thing more than once. I cannot sell more than %100 of anything. Doing otherwise is called fraud. An institution which requires you to use the same bottle of contrast on more than a single patient is committing fraud. This type of fraud has been going on too long. Health Workers need to wake up and stand up for their patients. If you are one of the people I mentioned You cannot play dumb any more and need to do the right thing for your patients in your charge and for the country.
As a legitimate medical supplier, one that tries hard to be compliant with all myriad and costly rules of Medicaid and Medicare- I am not surprised by the "broad brush" with which the business is being painted. However I have been around medical business since 1980 and, if the Govt were to  have used some simple  rules,  billions would have been saved  a long time ago. This is true not only of healthcare but check out Social Security- we hear the same stories, true or false every 4 years or so. I think that the "waste" in the Medicare program is simply par for the course when it comes to the beauracracy and red tape of the Federal  government.
 Why don't you print my comment about being on the other side of the line. when the medicare system rips you off, and you almost starve because the don't want to pay you what they owe you.
Kindly explain how medicare approves a doctor, a medical supply house or anyone.

What is the procedure? Does a doctor have to show proof that he is a doctor? Does he or anyone makeup a story and then submit their story to medicare? Is it that easy to get approved?

Hope you can do an in depth investigation.
Given that the majority of fraudulant medicare billing is taking place in Miami/Dade County and in South Florida...Why does the federal government and Medicare continue to pay doctors serving this area a higher rate for their services than Medicare contracted providers serving the rest of Florida providing the same medical services?  Why do they continue to "reward" the rampant criminal behavior of these counties, companies and physicians?  Are the beneficiaries of South Florida paying a higher medicare premium rate?  Most likely...No.  The cost of living or doing business does not vary drastically between Tampa and Miami yet, physicians serving medicare patients in the tampa area and the rest of Florida are paid a substantially lower fee for their services than those physicians providing the same services in Miami/Dade County. Where is the logic in this practice? Is there any wonder these corporations and individuals set up shop in South Florida?  A complete examination and overhaul of the system is needed.  
Federal Health Programs are outrageous.  Our seniors and disabled are barely able to retain their benefits because they don't understand the processes.  Our needy cannot pass the criteria to obtain Medicaid, but aliens can.

CMS structure is part of the problem.  Do they verify the information they receive.  Insurance companies require site visits.  Why not put some money into verifying the providers?  Stop penalizing the Legitimate Providers with cuts in GPCI and payments.  Obviously - the money was there.  It just went to the wrong place.  


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