Medicare Fraud: How can this happen?
Posted: Tuesday, December 11, 2007 1:05 PM by Barbara Raab
By Mark Potter, NBC News correspondent
Editor's note: Part Two of Mark Potter's Medicare fraud report airs tonight on the broadcast. Watch a preview here.
In reporting on Medicare Fraud, my colleagues and I spent a lot of time wondering how so many of the blatant and outrageous schemes we ran across could have actually worked.
For example, why would Medicare pay for two artificial arms and two artificial legs each for patients whose arms and legs are perfectly fine? A cross-check of the patients' medical records would have shown that none of them ever had amputations performed, and certainly not quadruple amputations.
How do tiny offices that look like closets and that are devoid of any medical equipment and make no pretense of legitimacy get away with billing Medicare for millions of dollars and end up getting paid a good portion of that amount, for services never rendered, for patients never served? And why were so many questionable applicants ever approved to bill Medicare in the first place? Surely many of them would never pass a basic background check, and certainly not a follow-up inspection.
And how do the numbers below add up?
Kirk Ogrosky, a Justice Department prosecutor who ran a Medicare fraud strike force in Miami, said investigators discovered that in Miami-Dade County alone, 1,100 patients appeared on Medicare payment records as having each received a million dollars or more in medical equipment in just one year. Each person! That's an awful lot of equipment, and in the eyes of the investigators, an absolute impossibility.
While those patients surely never got that much equipment, if any at all, Ogrosky said, what is certain is that at least $1.1 billion dollars was paid by Medicare to cover those bills. Now how did that happen? And who is walking around with all that money that's supposed to pay for health care for America's seniors and the disabled?
Our time spent reporting on Medicare Fraud has left us shaking our heads, and feeling quite discouraged. Who is minding the store that criminals have now made their home? Where is the outcry, and where is Congress in all of this?
In Part Two of our series on NBC Nightly News with Brian Williams tonight we will look at how Medicare began with much fanfare and promise 42 years ago, and will then explore why it became such a ripe target for criminals. It's a sad, but extremely important, story for all of us. Ultimately, we are the ones paying those thieves.
We've said it before, and it bears repeating: law enforcement officials estimate that each year $60-Billion is stolen from Medicare, hurting patients, honest doctors, legitimate medical suppliers and every American taxpayer. That estimate is their best guess. No one really knows for sure, and some suggest the fraud cost is much higher. It explains why a frustrated veteran investigator insisted to me the other day that Medicare fraud is an "epidemic," and that "the system is broken."
Not very comforting.
