Medicare fraud: outrageous

Randy Lazar — Wed, 05 Dec 2007 19:13:38 GMT

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.

Medicare fraud: outrageous

GERALD T. CAPAK, VERO BEACH, FLORIDA — Mon, 10 Dec 2007 18:30:04 GMT

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.

Medicare fraud: outrageous

Stan Ruffner, Oklahoma City, OK — Mon, 10 Dec 2007 18:35:51 GMT

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.

Medicare fraud: outrageous

Jackie Rawlings Riverside California — Mon, 10 Dec 2007 18:36:43 GMT

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.

Medicare fraud: outrageous

Dan, Ulster County, NY — Mon, 10 Dec 2007 21:57:50 GMT

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.

Medicare fraud: outrageous

Steve, Sellersville, PA — Mon, 10 Dec 2007 21:58:47 GMT

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....

Medicare fraud: outrageous

Ken Wiese — Mon, 10 Dec 2007 22:16:13 GMT

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.

Medicare fraud: outrageous

Marshall, Washington, DC — Mon, 10 Dec 2007 22:21:24 GMT

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

Medicare fraud: outrageous

Rogelio Ribas (in the name of my dead grandmother) Miami, FL — Mon, 10 Dec 2007 22:21:48 GMT

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????????

Medicare fraud: outrageous

Simon , Cleveland,Ohio — Mon, 10 Dec 2007 22:24:07 GMT

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.

Medicare fraud: outrageous

RP, Gilbert, AZ — Mon, 10 Dec 2007 22:55:15 GMT

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: outrageous

Greg P Marion In — Mon, 10 Dec 2007 23:37:58 GMT

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.

Medicare fraud: outrageous

john, Grand Blanc, Michigan — Tue, 11 Dec 2007 00:01:30 GMT

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: outrageous

Rema Herzbrun, Lady Lake, Florida — Tue, 11 Dec 2007 00:04:43 GMT

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.

Medicare fraud: outrageous

please — Tue, 11 Dec 2007 00:07:23 GMT

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.

Medicare fraud: outrageous

L. West Philadelphia PA — Tue, 11 Dec 2007 00:17:33 GMT

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.

Medicare fraud: outrageous

Elaine, Glocester, RI — Tue, 11 Dec 2007 00:31:37 GMT

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!!

Medicare fraud: outrageous

Brenda Person, Fort Smith, AR — Tue, 11 Dec 2007 00:38:35 GMT

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.

Medicare fraud: outrageous

Tom Polston — Tue, 11 Dec 2007 00:40:50 GMT

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.

Medicare fraud: outrageous

Steve, Deer Lodge, TN — Tue, 11 Dec 2007 00:56:01 GMT

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: outrageous

Carol Owen, Mesa, Arizona — Tue, 11 Dec 2007 01:10:41 GMT

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???

Medicare fraud: outrageous

Grizzy Miller, Pedi Stat, Inc., Miami, Florida — Tue, 11 Dec 2007 01:17:16 GMT

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.

Medicare fraud: outrageous

Brian, Philadelphia, PA — Tue, 11 Dec 2007 01:39:18 GMT

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.

Medicare fraud: outrageous

Jack, Minneapolis, MN — Tue, 11 Dec 2007 01:54:04 GMT

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.

Medicare fraud: outrageous

john doe — Tue, 11 Dec 2007 02:09:35 GMT

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

Medicare fraud: outrageous

Neil Trickett, PT , Boynton Beach, Florida — Tue, 11 Dec 2007 02:19:14 GMT

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!

Medicare fraud: outrageous

Ticked Off at Being Ripped Off — Tue, 11 Dec 2007 02:20:28 GMT

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!

Medicare fraud: outrageous

Artie Taylor, Los Angeles, CA — Tue, 11 Dec 2007 02:25:13 GMT

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.

Medicare fraud: outrageous

Paula Thomas, Spokane, WA — Tue, 11 Dec 2007 02:30:35 GMT

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

Medicare fraud: outrageous

Susan Wasson, Osakis, Minnesota — Tue, 11 Dec 2007 02:35:25 GMT

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.

Medicare fraud: outrageous

Debi Guenterberg Princeton, WI — Tue, 11 Dec 2007 02:35:46 GMT

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!

Medicare fraud: outrageous

Ann Whitley, Graham Washington — Tue, 11 Dec 2007 02:40:30 GMT

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.

Medicare fraud: outrageous

Larry Metzler — Tue, 11 Dec 2007 02:48:18 GMT

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........

Medicare fraud: outrageous

Kathy, Cincinnati, Ohio — Tue, 11 Dec 2007 02:55:32 GMT

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?

Medicare fraud: outrageous

Tim Murphy, Ballston Lake — Tue, 11 Dec 2007 02:55:42 GMT

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.

Medicare fraud: outrageous

Bat — Tue, 11 Dec 2007 03:01:19 GMT

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?

Medicare fraud: outrageous

Monce, San Pedro, CA — Tue, 11 Dec 2007 03:06:22 GMT

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.

Medicare fraud: outrageous

Richard Fabiano — Tue, 11 Dec 2007 03:06:35 GMT

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.

Medicare fraud: outrageous

Richard Pittsburgh, pa. — Tue, 11 Dec 2007 03:07:23 GMT

Medicare fraud: outrageous

Raul, Miami ,Florida — Tue, 11 Dec 2007 03:16:28 GMT

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!!!

Medicare fraud: outrageous

JAMES OTTO OCALA FLORIDA — Tue, 11 Dec 2007 03:17:42 GMT

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

Medicare fraud: outrageous

LESTER — Tue, 11 Dec 2007 03:24:40 GMT

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.

Medicare fraud: outrageous

Rod Beauchamp, High Springs, Florida — Tue, 11 Dec 2007 03:52:30 GMT

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..

Medicare fraud: outrageous

RJ, Watertown, CT — Tue, 11 Dec 2007 03:55:55 GMT

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.

Medicare fraud: outrageous

David Columbia, Birmingham,Alabama — Tue, 11 Dec 2007 03:56:51 GMT

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.

Medicare fraud: outrageous

Roy Guscott, Miramar, Fl — Tue, 11 Dec 2007 03:57:24 GMT

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.

Medicare fraud: outrageous

john doe albuquerque new mexico — Tue, 11 Dec 2007 04:01:31 GMT

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.

Medicare fraud: outrageous

michael Skrypzak erie pa — Tue, 11 Dec 2007 04:10:59 GMT

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.

Medicare fraud: outrageous

Debbie Simpson, Tampa, FL — Tue, 11 Dec 2007 04:18:42 GMT

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.

Medicare fraud: outrageous

Tara, Sarasota, FL — Tue, 11 Dec 2007 04:28:42 GMT

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.

Medicare fraud: outrageous

stephen g powers — Tue, 11 Dec 2007 04:30:29 GMT

I'm on medicare and find this so sick,medicare should set up id numbers to companys who provide services and the company owner should have a crimial and other back ground check.Then the store should be checked out before they can open for business.Anyone who defrauds medicare should be looking at a long time in prison.The government can find ways to stop alot of these fake companys from opening in the frist place and every month they have to send records to a check system.To make sure the company is real. Before medicare pays for for supplys,they can check supply company id's,which has had crimnial back ground checks and finance record of the owners and companys.This has to stop now.

Medicare fraud: outrageous

Steve, Ladysmith, WI — Tue, 11 Dec 2007 04:48:11 GMT

I think they better look at the health clinics also, you get a flu shot for $12.00 and they also charge medicare $17.00 for giving it to ya, and the whole thing took about a minute.
also I would like to know how they pay, I have Arthritis and get foot infections a lot and the Doctor wrote a precription for special insoles, medicare will not pay for them unless you have diabetis, how can the goverment discrimate and nobody else can do it.

Medicare fraud: outrageous

Melodee Sortedahl — Tue, 11 Dec 2007 04:50:46 GMT

Anyone on Medicare understands how easy it would be for thieves to use their medicare number and they would not even know about it. I am a college-educated person, intelligent, on top of things, but after 9 years, not once have I have been able to figure out my husband's medicare statements.

Medicare fraud: outrageous

R. James Fenton, L.P.O., Miami, Florida — Tue, 11 Dec 2007 04:56:48 GMT

Having been a Medicare "Provider" since its inception in 1966, I can tell you that nothing changes for the better. "Provider Numbers" were supposed to prevent fraud. Now NPI numbers are supposed to prevent fraud, they won't! CMS has neither the talent, desire nor intesinal fortitude to make their contractors take responsibility for their gross incopetance. CMS CANNOT IDENTIFY WHO IS OR IS NOT AN AMPUTEE! When a CMS contractor screws up, they (the contractors) pour on the regulations TO THE PROVIDERS, with CMS blessings! One simple question: Why does my government trust me to pay my rent & buy my food yet does not trust me to buy my healthcare? If I'm trustworthy enough to spend my Social Security check wisely, then why can't I be trusted to purchase my own healthcare using the money that I've paid in, just like my social security?
Yes, individuals can also be taken advantage of but, the numbers are in our favor not the thieves! As it is now the thieves only have to take advantage of one entity, using multiple individual's names and I.D. numbers. It would be next to impossible to take advantage of thousands of individuals buying their own healthcare.
Also, CMS has such an assortment of laws, local policies and directives that many are in direct conflict of one another as well as Federal Law. One such example is that I MUST have an original signiture on file for any item that I deliver (apply or fit) to a Medicare patient. YET, it perfectly legal for me to put the same item in a box and ship it to the patient, providing that he/she signs for the item. Have you EVER seen an "ORIGINAL" signiture provided by UPS or FEDEX? CMS needs to get its own house in order, instead of dumping on me and other providers in the name of stopping fraud. Yes, the fraud needs to be stopped, but CMS hasn't look for the answer, only the scapegoat!

Medicare fraud: outrageous

Dean Smith Palm Desert, California — Tue, 11 Dec 2007 04:57:01 GMT

My thoughts go back to the Founding Fathers who knew that in order to have total freedom, a moral compass would be required of each citizen.

Many people have no conscience, and feel that if they don't get caught, it must be alright to cheat.

What is not mentioned in the article is that MANY of the "cheaters" are newly arrived immigrants.

Medicare fraud: outrageous

Marty CR Iowa — Tue, 11 Dec 2007 04:58:31 GMT

I checked my hospital bill for a 5 hour trip to the ER, it went to medicare and they paid the 80%, but I was billed for $2,285.00. I protested this and asked for an itemized bill to be sent to me. There were many things listed on there that I did not receive, a MRI, a TVUS, an eltrocardiagram reading, lots of blood work and many drugs. I went to the ER for low blood sugar. They did a blood sugar on me took my BP gave me an IV of 5% dextrose and sent me home. They blamed it on the office transcriber. I followed through on this and asked that medicare be reimbursed for the over payment and that this be taken off of my record. I received a nice letter from BC thanking me for following through. My entire cost was brought down to $78.00 It took 9 months to settle this. I also had to get this removed from my credit report as the hospital turned me in for non payment. Always check your billings from any clinic or hospital regardless of insurance holder.

Medicare fraud: outrageous

Ron Kohn — Tue, 11 Dec 2007 05:05:23 GMT

Mike Leavitt certainly shouldn't be surprised by the cases of Medicare fraud. He must know of Jeb Bush's (the president's brother) involvement in the largest case of Medicare fraud. Ask anyone in the Miami area and they will relate the story of one Recarey and his relationship with Jeb Bush. Recarey fled the USA to avoid prosecution. A five minute web search will reveal the whole story.

Medicare fraud: outrageous

inspector Los Angeles — Tue, 11 Dec 2007 05:06:13 GMT

When our bitterness at the waste becomes so great then we will become active in our government again; until such time that we the citizens become involved and report the abuse then it will stop.

Medicare fraud: outrageous

Ally Hauptmann-Gurski — Tue, 11 Dec 2007 05:25:35 GMT

We have medicare in Australia and as far as I know, fraud is not an issue.
Come on down, take a look, study, in your language, and then imitate!

Medicare fraud: outrageous

Danny, Denver, CO — Tue, 11 Dec 2007 05:35:00 GMT

Just think of all the fraud the tax payers will have to pay for if the Democrats get their wish of Universal Health Care. The government is sure doing a great job with Medicare.... What a joke!

Medicare fraud: outrageous

the SASS Man, Spokane, WA — Tue, 11 Dec 2007 05:46:16 GMT

Greed is both the greatest scurge to our financial industries and its greatest benefactor. Remember that the same kind of greed that drives these fraudsters to rip off the American people also drove the founders of all -- EVERY ONE -- of America's corporations. Yes, we need to get better government accounting, and, yes, we need to catch and prosecute these criminals, but greed is one of the most powerful and pervasive of American traits. Fraud will not be stopped until it can be made un-lucrative. So, too, with drugs, pornography, and, yes, legitimate business as well.

Medicare fraud: outrageous

robert a. rotondo, sterling heights, michigan — Tue, 11 Dec 2007 06:04:21 GMT

What a surprise! government run program and fraud. when will we get it. bureaucrats and government employees do not care. it is only taxpayer monies. the free market is the only way to limit fraud...including health care.

Medicare fraud: outrageous

Jean Hale, Oregon — Tue, 11 Dec 2007 06:08:58 GMT

If you want to see a huge opportunity for fraud, check out equipment for sleep apnea, CPAP masks in particular. Medical equipment companies double or triple the original price and then sell some aspects of the masks as if they are separate equipment. They will sell the cushion of the mask as if it is a separate piece. You can't buy this cushion separately from the people that make the masks. This is like going into Walmart to buy your child a turtle and being changed $3.00 for the turtle (that originally cost Wal Mart $1.00) and $2.00 more for the shell. When you consider the numbers of people being treated for sleep apnea, the profits these practices bring to these companies is staggering.

Medicare fraud: outrageous

IVONNE GONZALEZ - MIAMI, FL — Tue, 11 Dec 2007 06:13:27 GMT

As an owner of a small medical equipment company in Miami that provides Medical Equipment, Orthotics and Mastectomy Products for the last 14 years, have been accredited for the last 10 years and I sit on the Board of the Florida Association of Medical Equipment Dearlers for the last 12 years, I will like to request that you include in your program a section on legitimate providers in South Florida. There are many companies that are providing excellent services but because they are in South Florida they are all targeted at the same time. Payments are being denied by Medicare stating that services were not provided and they were. In order to get pay the company has to send a copy of all documentation in patients file and this will take approximately 3 to 6 months. If payment is denied again the company will need to request a Hearing with an Administrative Law Judge and this could take up to a year or more. All of this could be prevented if Medicare just call the patient and check if they receive the services.

Medicare fraud: outrageous

Elizebeth Harmon, MD, Salem, Oregon — Tue, 11 Dec 2007 06:35:08 GMT

Why have we spent millions of dollars worrying about physicians working in the trenches and actually taking care of medicare clients. We spend countless hours reviewing our charting to make sure that we are "coding" correctly so that we can get paid 35 cents on the dollar and then worry that we may have put down the wrong code. Maybe we are barking up the wrong tree. Let's actually stop some real fraud and take the money that we save and pay physicians a fair price for their services.

Medicare fraud: outrageous

Craig C — Tue, 11 Dec 2007 06:36:42 GMT

Maybe if our government officials (meaning especially the House and the Senate) weren't so busy stabbing each other in the back and trying to squirrel money away for their pet projects we could afford to put enough people in place to oversee these programs and reduce or eliminate the fraud.

Maybe I'll write my Congressman. Naw! Forget it. I'll just get a canned email back thanking me for my support and telling me about the hundred thousand dollars we're going to spend to put up a statue in some town I never heard of in West Virginia in honor of Robert Byrd. What a country!

Medicare fraud: outrageous

Renee Gibson, Meridian, MS — Tue, 11 Dec 2007 07:08:39 GMT

If you think it is bad in Florida and Houston, you should check Mississippi! I hate for people to say Mississippi is the poorest state in the nation. Truth be told, we are sinking most of our federal and state dollars into supporting people who actively commit Medicaid and Medicare Fraud. When you call to turn these people in, the people at the state office simply don't give a damn. In Mississippi, it is more of the patients committing fraud than companies. They doctor shop. They get prescriptions filled that they flush down the toilet. Some of them pretend to be "crazy" to get a disability check. Others make their children pretend "craziness" for about $500/month. Seeing as how Mississippi is a mostly Republican state, you would think our lawmakers and representatives would care more. They don't give a damn, either. They never even address the fact that in Mississippi, you have whole generations of children, Black and white, being raised with this kind of fraud, while people who are in their 80s and 90s can barely get enough help to buy groceries. I feel sorry for college students and Mississippi seniors. When it comes to them, the state never has enough money. When it comes to people just plain being lazy, sitting on their behinds faking injuries, and having baby after baby, there's always plenty to go around while the rest of us citizens scratch our heads just to make ends meet.

Medicare fraud: outrageous

concerned future medicare receipant, usa — Tue, 11 Dec 2007 07:51:55 GMT

I work for a major pharmacy and work in the medicare billing dept. I see my company billing medicare in error all the time. This has been a huge problem with the company. CMS has been informed about this and did nothing. I know the company has received thousands and thousands of dollars that should be paid back to medicare but never is.

Medicare fraud: outrageous

Rick, Pomona, CA — Tue, 11 Dec 2007 09:43:09 GMT

We are a nation of smart people, we should be able to get a group of people to together and develop a punishment the will be an effective deterrent. Here are some suggestions. Punishments should be dished out to all involved - the Medicare care agency workers for being asleep at the wheel(demotion but reward them for stopping fraud by giving them a bonus base on a % of the $ saved), the patient who turn a blind eye to fraud (reduced benefits but again give them a inventive to report fraud - say 10-50K for every successful prosecution) and for the perpitrator (bullet to the back of the head like the poor Chinese sap for taking @800K in bribery is a bit much to ask) - but it's worth a shot.

Medicare fraud: outrageous

Dr. Dralves Gene Edwards, Cedar Hill, Texas — Tue, 11 Dec 2007 11:20:30 GMT

Well down in the wild, wild, WEST, Texas, medicare ran me out of business for doing home visits and saving them thousands of dollars. I guess being a black doctor makes the difference in getting catch. After FBI, OIG, State Board of Medical Examiners and a 6 year administrative marathon, am still trying to get my name back. All doctors are not out to robe Medicare.

Medicare fraud: outrageous

Mark Ellis , Greencastle, Pa — Tue, 11 Dec 2007 13:18:49 GMT

The "durable medical equipment Medicare benefit accounts for less than 2 cents of each Medicare dollar spent. The same degree of fraud and abuse exist in Hospitals, Physician practices, Labratories and any sector of healthcare but the numbers are much higher. Yet again and again the media reports on this small segment. Where's the balance in reporting to the people the entire story of the mess in our great country's healthcare system? Is there a political agenda that news media has an interest in that makes it desirable to concentrate it's efforts on this small but efficient and effective component (minus the few ripoff artists that take advantage of the system our government set up) of our national healthcare system?

Medicare fraud: outrageous

William A. Rowell — Tue, 11 Dec 2007 13:34:51 GMT

Like Crime, fraud is where you look for it. You will probably find fraud in any industry you choose to turn your camera's on. I attended a meeting last year where thoe OIG admitted it saves the government more money that the government spends to run the OIG. I say let the Government take the savings and spend it on enlarging the OIG.

Medicare fraud: outrageous

J. DAVIS ...HOUSTON TX — Tue, 11 Dec 2007 13:57:53 GMT

IT DOES SEEM THAT WE ARE SINGLED OUT ...STILL MANY BILLIONS LOST ARE ALSO ATTRIBUTED TO THE HEALTH PROFESSION IN GENERAL ...DOCTORS NURSES AND HOSPITALS WHO IN SOME CASES BILL MANY MILLIONS MORE FOR FRAUDULENT SERVICES THAN WE EVER COULD ..WHY IS THIS NOT BEING SINGLED OUT ...WE ARE ONLY A FRACTION OF MEDICARE SPENDING ...REPORT IT FAIRLY...DOUBTFUL .......IS THE FBI ONLY TAKING THE REPORTER TO KNOWN FRONTS ..OR IS HE GETTING HIS FAIR SHARE OF LEGITIMATE BUISNESS INTERVIEWS ...IF HE COMES AND SEE.S ME I CAN TAKE HIM TO 1 BUILDING THAT HAD 40 FRONTS ..OR I COULD ALSO TAKE HIM TO 100 LEGITIMATE SUPPLIERS IN THIS BUISNESS ...HOW OBJECTIVE IS HE WILLING TO BE ...???

Medicare fraud: outrageous

Denise, Jackson MI — Tue, 11 Dec 2007 13:59:16 GMT

I have been in this industry for 17 years and have worked with many other HME companies that are not only above the reports that you have provided but offer superior service to our aging. The area you are reporting on is old news. Why don't you report on companies that are doing good things for the HME industry, that belong to state and national associations, and are accredited to abide by the suplier standards. I can name many thoughout Michigan and the midwest who do just that. If the government gave out supplier numbers without thorough investigation of their business practices, then they should be held accountable. Not the rest of the industry who are the good guys.

Medicare fraud: outrageous

Paul whelton Middletwon, DE — Tue, 11 Dec 2007 14:10:52 GMT

The loonies on the left continue to believe that Medicare and other government fraud are the fault of the Bush Administration alone as if these were new phenonema. News for the loonies: people have been scamming the US, state and local governments since day one back in 1789. The reason, government workers! They have zero incentive to do a good job and of course in 2007 zero accountability when they do a bad job. No one ever gets fired in government La la land except for murder, rape and pillage. Medicare scams will continue as long as we allow our money to be administered by government employees. We need to privatize and incentivize Medicare watchdogs to nail the bad guys. If you want to catch rabbits you use grayhounds not drayhorses.

Medicare fraud: outrageous

Mike, Texas — Tue, 11 Dec 2007 14:40:48 GMT

Be very careful not to blame the true Medicare providers for Medicare's blatant disregard in making it easy for thieves to steal taxpayers money.

Wasn't there a famous criminal that said he stole money from banks because, "that's where the money is." Obviously, these criminals know where the money is...

Medicare fraud: outrageous

Ch — Tue, 11 Dec 2007 14:42:31 GMT

Pay investigators 1% of the frauds that they uncover. This is the cheapest way to clean this up and keep it cleaned up! Send the bills directly to these investigators before Medicare pays the bill.

Medicare fraud: outrageous

Stephen Trost, RN, Minneapolis — Tue, 11 Dec 2007 14:42:42 GMT

Private insurance companies, not for profit only, should receive a set number of dollars to care for each Medicare beneficiary. The Federal government should no longer try to be an insurance company, it doesn't work. I am a RN specializing in Medicare who is ethical and careful with the taxpayers money while at the same time ensuring proper access to Medicare benefits to enrolees. However, there are MANY gray areas in healthcare and shifting the care to local insurers would work much better.

Medicare fraud: outrageous

kbcarter — Tue, 11 Dec 2007 14:59:05 GMT

"..just imagine the thievery that will occur if a national healthcare program is implemented...."

That's ridiculous and nothing but typical government hating right wing rhetoric and fearmongering. It's the same baseless and ignorant mentality that keeps us from importing safe drugs from Canada. Self serving simpleton garbage, nothing more, nothing less.

Medical fraud can be fought effectively with the right resources and people. It's all a matter of priority.

Medicare fraud: outrageous

Charles Martin — Tue, 11 Dec 2007 15:14:00 GMT

How about severe penalties, including death for defauding the taxpayers. They can't be treated like white collar criminals anymore.

Medicare fraud: outrageous

Judi Bayes, Largo, Florida — Tue, 11 Dec 2007 15:51:01 GMT

I have been involved in the medical equipment industry for 30 years and have seen fraud escalate because CMS has allowed it to happen.

Simple steps have not been implemented to prevent fraud from occurring.

For example:

• A new provider with an immediate client base should throw up red flags.

• A physician's ID number used multiple times for like equipment during a month should be investigated.

• A diagnosis used with beneficiary numbers under Part B which does not coincide with diagnoses registered under Part A and where no physician visits or hospitalizations are billed and yet medical equipment is being prescribed are triggers that something is amiss.

• A medical equipment serial number detected if used more than once could be easily spotted.

I could go on and on.

Someone needs to be held responsible for maintaining an agency without seemingly simple mechanisms in this day and age that would help curtail this abuse.

In the meantime our company stopped serving new Medicare clients because Medicare would not pay for the complex rehab equipment we provide. People are being denied access to the reputable equipment providers because CMS has not done it's job of protecting those dollars paid in by the American people.

Upper management at CMS needs to be held accountable now!

Medicare fraud: outrageous

K Firestone Naples FL — Tue, 11 Dec 2007 16:20:08 GMT

I own a company that should be collecting Medicare dollars but am unable due to the fact that the Nursing homes in my area collect the monies then refuse to reimburse the contractors. They make the patients pay the bill .. now thats fraud! I have complained to Medicare and AHCA, it does no good, they look the other way. Facilities in my area are stealing on average about $4,000,000/yr. Since we have 9 local facilities and they ALL do it, thats $36,000,000/yr. AHCA doesn't care! They know it, its been reported by the patients as well. Homecare agencies in this area are another huge defrauder of Medicare, ACHA looks the other way for them too! I see it EVERY day.

Medicare fraud: outrageous

Sandra London-Leib — Tue, 11 Dec 2007 16:22:21 GMT

Medicare has created a large and very expensive arm of the government. They continue to add staff and programs while not doing their core mission. If CMS had been doing their job from the start and policing it's self as well as provider industries, fraud would be almost nonexistent. Instead very little has been done over the years. Now as we face a silver wave that will engulf all health care services, CMS is frantic to cut costs. Fraud now is the least of their problems. When people go into nursing homes because they lack the availability of home medical equipment and those connected services, the taxpayers will be paying a much, much larger bill. Right now politics is fueling this attention and while I agree that all fraud should be examined and eliminated, we must be very careful about not cutting so deeply that we all bleed.

Medicare fraud: outrageous

Robert G. Montgomery, Greeneville, TN — Tue, 11 Dec 2007 16:24:19 GMT

While Medicare is being ripped off with fraudulant claims for equipment, every Senior Citizen on Social Security, is also being ripped off by the increasing Medicare monthly premiums.
In the 6 years I have been retired, collecting just Social Security, the monthly deduction for Medicare premiums taken from my check, has increased more than 112%. Plus, I pay a monthly premium for supplimental insurance as well, which has also increased over the years. Bringing my total monthly cost for Medical coverage, so far, to more than $140.00 per month. Each.(myself and my wife) This is out of our only income. Social Security.
How's that for trying to cope with overall increasing costs?

Medicare fraud: outrageous

Bill Atkins, Independence, MO — Tue, 11 Dec 2007 16:25:27 GMT

Owner's of the business out of the country? If the inspections are carried out properly before issuing a Medicare number and things look fishy why aren't the inspectors returning. $500,000.00 a month in sales for a new business. Does that send up any red flags? does the paperwork show the same Doctors name on every prescrition? Sounds like another red flag. did anyone check the serial number being billed? Did anyone call the manufacturer and see if the company bought any wheelchairs last month? They would have had to if they billed $500,000.00.The fraud department needs some advice from the legitimate suppliers in the industry. The government gets bilked, the criminals leave the country, or get put in jail, very little money is recovered, the guys who follow the rules clean up the mess.The story never really changes.

Medicare fraud: outrageous

Mike Pittsburgh, PA — Tue, 11 Dec 2007 16:58:25 GMT

Jackie Rawlings, you are worried about what Bush and the GOP are doing and they dont talk to you, but Hilary and the Democrats are doing a lot about it now arent they? They have had control of the House and Senate for over a year and have accomplished nothing. Who are you going to blame if they ever get total control and you can't get your medication because they never got around to doing anything? Get educated by getting facts, dont rely on Dan Rather for your facts and information.

Medicare fraud: outrageous

M. Preisz, Forest Hills NY — Tue, 11 Dec 2007 17:02:24 GMT

You are right, fraud is rampant, however you also should report, that as a result, the legit disabledhas jump tru hoops in order to receive durable equipment, people with spinal injury, MS, Post Polio. These are progressive or stable conditions ergo we should not have to through months of paper work questions and doctor visits in order to receive what we need. Please remember we worked payed into the system, not asking for handouts. This not an entitlement program, this ie insurance.

Medicare fraud: outrageous

Stephanie Baeseman, Wausau, Wisconsin — Tue, 11 Dec 2007 18:11:56 GMT

$60 billion dollars a year. If the Bush family lost this much in fraud, would there be an investigation and stronger quidelines to received medicare payments for services rendered? What an outrage that a government is not disgraced by this fraud under their administration. If I lost a fraction of this amount of money, I would not be able to face the people I know for my stupidity.

Medicare fraud: outrageous

Jessica Mathews, Columbus, Ohio — Tue, 11 Dec 2007 18:12:49 GMT

I was at the dinner table last night with my sister and mum when this piece about 'Medicare Fraud' came on and I was absolutely disguted. Writing this, I even feel that 'disguted' is such an understatement.
Reading the other comments, I read one regarding 'National Health Care' and I'm interested as to why you think that would be even worse? Of course most 'news' is distorted and 'we' the public only seem to get a 'breeze' of other countries healthcare system. Forgive me but, I rarely hear negatively about Socialized Health Care.
I'd love to investigate and exploit fraudlant activity in my area if I could regarding Medicare. If someone can tell me what I can do or where I can start, I'm all about being a whistleblower and making these people pay!

Medicare fraud: outrageous

William Little — Tue, 11 Dec 2007 18:32:12 GMT

Hurray for NBC News

On two successive nights, NBC news gave extensive time
out of their 20 minutes of evening news to report on stories the "MEDIA OUGHT TO BE SPENDING TIME ON" instead of every dumb political propaganda sound bite and misbehaving celebrity.

I am referring to the story on Friday, Dec 7 about the Canadian who financed and set up Canada Town to help the victims of Katrina. Then on Monday Dec 10, you followed up with a story on Medicare Fraud. I could not help but notice that 8 million private dollars went a long way in Canada Town while 5 million taxpayer dollars went for one wheelchair in the Medicare Fraud story. Think of how far that 60 billion in Medicare Fraud could go to help our physically and mentally disabled veterans! That is a story combo that could use a lot more coverage.

I think we could go a long way to reducing these fraud problems with some good old capitalistic incentives. Congress needs to set up a fraud busting task force of FBI and IRS agents and offer rewards of 10 percent of fraud uncovered. We need fraud sentencing guidelines that take these crimes seriously.

Medicare fraud: outrageous

Sarah Wain, Yakima, WA — Tue, 11 Dec 2007 19:51:26 GMT

Noridian, the company, contracted by the government,
should be investigated for this fraud occuring.

Recently, Noridian changed their billing form (CMS 1500)which is used nationally and by all insurance
companies. The instructions for completing the form were 20 PAGES, yes, 20 PAGES, and so confusing many prividers have gotten claim kickbacks after kickback from Noridan because of the confusion. With all Noridian's requirements, it is so difficult to believe that all this fraud was not detected

New Federal Provider Identification (NPI's) were issued and all providers were required to apply for them and use on the new billings. These NPI numbers were to be cross checked with the providers old Medicare UPIN numbers and coincide to prevent any fraud. Has this fraud been overlooked because none of our representatives ever check on Noridian's performance. I don't think any new president or any of our representatives have the backbone to correct all the blunders made by our federal government - immigration, war, healthcare and social security, welfare, the mortgage mess, overpopulation depleting all our resources, escalating gas, food and utility costs that are driving older retired people out of their homes. Our government needs people in office that are not whimps and are able to say "NO MORE"

Medicare fraud: outrageous

Fay, San Antonio, TX — Tue, 11 Dec 2007 22:20:17 GMT

I work for an accrediated DME company. We pay for the Community Health Accrediation Program to survey our company. We are heavily regulated and have to follow the rules and regulations of Medicare. Unlike other fly by night companies selling Durable Medical Equipment. Almost all equipment has to have a prescription from a Medicare certified physician. We are not a wife or family member of an orthopedic, pulmonologist or cardologist selling a CPM machine, oxygen or other durable medical equipment. Also unlike other providers like: Walgreens, CVS, and Walmart our patients are given explicit instructions on how to use the equipment. Providers need to have an ethical and moral obligation to their patients and unfortunately in todays society there is not much ethics or morals. Just the almighty buck. And there is always a criminal element, just look at the drug dealers now in Durable Medical Equipment in Florida and probably Houston, TX.

Medicare fraud: outrageous

Donald Baun, Columbus, Ohio — Wed, 12 Dec 2007 00:08:48 GMT

The Republicans have always told us "Put us in charge of the management of programs of government because we are professionals and we are better managers. With such professional management one would expect little to no Medicare fraud. Could the skill level of Republicans be only so much hot air?

Medicare fraud: outrageous

Renee Gibson, Meridian,MS — Wed, 12 Dec 2007 00:14:56 GMT

Dear Dr. Edwards,
I'm sorry to hear this. I think Medicare/Medicaid is broken and it needs to be fixed. I was reading other bloggers who Medicaid/Medicare has screwed over, so you are not alone. It seems as if doctors like you, small businesses, and the elderly are the only ones that get punished under this system. And, being Black and from Mississsippi, I don't think it has anything to do with color. I know young, healthy people both black and white, who could get off of their asses and work, and who live quite nicely off of Medicaid/SSI disability checks. I don't know any elderly people, white or black, who have this luxury. I, personally, have called and called to report just rampant and shameful medicaid/disability fraud in Mississippi. The people at the office in Jackson laughed at me. Some even got a little flippant with me. And then you have to look at the nepotism factor. Some people "get in good" with Medicaid/Disability workers, and no matter who protests, they don't get caught. I am so enraged because my Dad is a Vietnam veteran who must pay for medication when he goes to the VA hospital. My neighbor sits on her ass all day watching soap operas and keeping up shit, does not work, and lives very well on her Medicaid/Disability checks.

Medicare fraud: outrageous

George Stewart, Stuart, Florida — Wed, 12 Dec 2007 00:17:57 GMT

Medicare is not interested in receiving reports of possible fraud. I have tried via telephone calls and then their so-called "hot-line" with multiple emails. I have yet to receive a reply from my numerous inquiries over more than a year. Please turn up the heat!

Medicare fraud: outrageous

Esther Murphy, Wilmington, NC — Wed, 12 Dec 2007 00:29:15 GMT

This is the most important domestic issue NBC has uncovered in my lifetime. I found fraudulent medical billing paid on my account as soon as Medicare took on prescription drugs. There is no one to report this to. Call Medicare and an automated message says all lines are busy, call back another time. I have waited on hold for hours, been automatedly disconnected and left messages at medicare contacts trying to report abuse and fraud. The humans I have contacted never follow through. No one is minding the store. We have no government accountabilty. It's a feeding frenzy.

Medicare fraud: outrageous

Robin Pelletier, Oceanside, CA — Wed, 12 Dec 2007 02:15:46 GMT

Mark, last year I lost my father of 75 years to Dementia/Alzheimers. As a 53 year old single woman with only 1 income, I relied on my father's health care resources - VA Benefits, Medicare and Medical. Since this was my first experience with all of this I had to learn quickly about what each resource would help me with in order to keep my father in my home and out of the neglectful, Medicare "bilking" nursing home care system. Unfortunately, I had first hand experience at how much fraud there is within the entire system. For months after his passing agencies sent me medication, nutrition supplements, diapers, and other supplies I used for his care. I notified them several times that my father had passed and wanted to return the items. I literally had to argue with them to return them. All items were in the original boxes and not opened yet they refused to return them. After months of arguing with them, I was drained and just wrote refused on them. For months I saw the bills come in from Medicare with outrages charges. When I complained to Medicare they gave me the run around and frankly did not know how to help me. Shame on the system. I am so glad that they are now under investigation it's about time!!!!!!!!. This is a travesty. Thank you for the story. Hopefully my generation will be angry enough to stop this fraud. Thank you. R. Pelletier, 54 Oceanside

Medicare fraud: outrageous

Herbert Riedl — Wed, 12 Dec 2007 04:47:50 GMT

I know,I would not get away with any of this for I am to damn honest. Shame on those who do it and our leagal system .

Medicare fraud: outrageous

Ken Wiese — Wed, 12 Dec 2007 05:44:44 GMT

Doc's often denigrate the rest of the Medical service industry, but many of them schedule their patients to return every 30 days like clock work whether the patient needs it or not. That in itself is a form of writing your own paycheck and is illegal vis a vis Medicare rules. Doc's are audited by Medicare only in extreme circumstances. Depending upon the patient's acquiescence, Doc's get to write their own meal ticket as long as they are willing to sign off on enough justification. No other provider can do that. That is the big secret that the AMA is lobbying to hide.

Medicare fraud: outrageous

Jo, Paducah Ky — Wed, 12 Dec 2007 15:50:54 GMT

Just one more post to say that this is no big surprise. My in-laws are both on the Medicare grift. Both are "disabled" and attend one certain "pain management" clinic about 4 times a week.

They spend their SSI checks on travel, big screen TV's and nice cars (we figure between the grifting of the Medicare and the SSI they're probably pulling in around $2500 per month, and of course they don't pay anything for their home either, thanks to HUD), and have been doing so for over 10 years.

My husband finally stopped trying to "save" them, and we've broken all ties with them.

I reported them and the facility over 3 years ago, on several occasions. Stating that if they have the ability to sit for long hours in a car, walk for miles while visiting places, and can perform the heavy lifting of suitcases into their car; then they can certainly work and are NOT disabled.

4 years have passed and gee guess what, they're still on the grift. No action whatsoever.

As a side note, my 70 yr old mother went to the same "pain management" facility last year for a knee injury, on a consult. They billed for several "proceedures" that never took place. She never went back and reported them...they're still in business.

Medicare fraud: outrageous

Dotti, Crossville, TN — Wed, 12 Dec 2007 16:28:17 GMT

-All the "rush" to pay and STILL, legit doctors claims are rejected month after month, having to be resubmitted several times before payment.

-Add that to the congress cutting payments to doctors and you will realize why fewer and fewer physicians will accept Medicare patients.

-And there is to be another huge cut next year and seveal years after!!!

-It won't be a prolem after a couple more years. Honest docs will not be seeing Medicare patients and you can just assume that all the claims are for fraud. Of course, by then, Medicare won't pay enought to make it worthwhile to cheat the system.

-Thanks, congress, you're screwing us again---just wish you had to use the same medical care systen that your constiuents use instead the gold plated one you will have for nothing!

Medicare fraud: outrageous

A concerned citizen, Miami, Florida — Thu, 13 Dec 2007 02:17:43 GMT

Private insurance does a better job at policing false claims than the Centers for Medicare & Medicaid Services (CMS), the agency within the Department of Health & Human Services that administers the Medicare program. Where is the investigative report comparing how private insurance administers their own programs with those government contractors that administer the Medicare program? Are there any insentives for these government contractors not to pay claims? If not, why would a contractor want to spend additional hours questioning the validity of a claim? Are there separate contractors looking for claims processing and fraud prevention? If so, how do they interact? If Miami is ground zero for fraud schemes, has Medicare directed the majority of its efforts in this area of the country? It sure doesn't seem that way...

Medicare fraud: outrageous

Robert Miller Gastonia N.C. — Fri, 21 Dec 2007 21:32:45 GMT

Why not have the recipeants of the care sign off on the bill before it is paid.

If they verify false claims they lose there benifits and get charged with fraud.

This is not rocket science and does not have to cost that much.

Medicare fraud: outrageous

DC, Tampa FL — Sun, 23 Dec 2007 12:10:18 GMT

$60 Billion in fraud? And we want universal Healthcare?

Medicare fraud: outrageous

Nancy Nurse, Florida — Sun, 23 Dec 2007 16:58:04 GMT

I've been in the healthcare industry for over 30 years, nothing has changed. Years ago it was a Medicare approved payment for a wheelchair cushion of $600 when the cushion only cost $60. Today it is a run away train. The system has been broken for a long time, and it seems no one is at all upset over this. I could give countless examples of waste and fraud, but no one is listening. The "legit" businesses overcharge and overcharge and overcharge; and when the individual questions, often the answer for it is "...factored into the cost is the cost of the labor intailled to provide that service". Well I am waiting for my windfall.......... Oh, thats right the big businesses, Hospital corps,Rehab Centers and Nursing Homes, just to name a few are the true winners in this game. The employees of these large corps could enlighten us in many other areas of abuse. Wake up America this is nothing new and for sure in another 30 years we will still be talking about waist and fraud in the system.

Medicare fraud: outrageous

Steve, NY,NY — Tue, 25 Dec 2007 06:19:42 GMT

Medicare and Medicaid fraud is only the tip of the iceburg at a cost of 60 Billion. That's with a "B" folks!!! Then there is the sub-prime mortgage fiasco at a cost that will eventually total over 100 Billion. That's another capital "B", folks. And the one that is NEVER spoken about because it would bring on another Great Depression is the SEC and it's "do nothing" attitude towards the BLANTANT CORRUPTION and MANIPULATION of the stock securitys market by the DTCC, the Market Makers, and the individual brokerages and their employees.
The "common" denominator here is GREED!!!! The crooks KNOW how to manipulate the system. The reason they can manipulate the system so easily is because they KNOW that the SYSTEM is broken and it can NOT police itself anymore and the most troubling part is that SEC (as an oversight agency) could care less about bringing the criminals to justice OR "FIXING" the system. Why, you ask?? Simple!! The corruption is so DEEPLY rooted, that IF the SEC or even MEDICARE/MEDICAID system WERE to try to STOP the corruption, the system would melt-down and collapise.
EVERY ONE of you writing to this blog including myself is partly to blame for this. We ALL feel helpless to do anything to stop the corruption. Your politicians will tell you anything YOU need to hear in order to get elected BUT once elected, their promises to the people rarely materialize except to ultimately cost us more in higher FEDERAL, STATE, COUNTY, and LOCAL TAXES with LESS benefits for those taxes.
I am appalled by what has happened to this country that I LOVE so much but I alone am helpless to do anything to change the system.
Once the true citizens of this country get tired of being pushed around by the power hungry and corrupt officals (who only care about their salarys and retirement packages) will be the day that things start to change BACK for the better. Until then, we're all toast.

Medicare fraud: outrageous

Jeff Messenger, Springfield, Missouri — Wed, 02 Jan 2008 16:30:37 GMT

It would appear to me that this problem has evolved into to large a problem for the federal government. It is the same old comment, it is difficult to be in more than one place at the same time. I recommend that the federal government turn the programs back to the individual states along with the medicare money to police their own states. This way the problem can be contained and the states individual law enforcement agencies don't have as large an area to cover than the federal government has. This may be a problem with " I don't want to give up jurisdiction " but the problems should be solved and this type of ego should not even enter into it. The money the federal governement is using to fight this problem could be dispursed to the individual states to help them fight the problem. Afterall we all have a stake in this problem as this is our future health care.

Medicare fraud: outrageous

Toby McR — Fri, 04 Jan 2008 12:50:46 GMT

When your name, SS#, address is picked by these individuals to committ fraud then you sit up and say I will contact my elected official, congress and senate, and they will take care of it....Wrong, my representative in both the congress and senate has yet to reply to any of my mail...My representative in both houses have become a joke . The repres. never sees your mail, only by the AA who then makes a decision as what to do with the mail. File #13, period.The local office in your area is again a joke.It is indeed a disgusting situation...What can I do..??Start sending copy of our mail to the local newspapers and then perhaps your local rep. will take notice...Toby

Medicare fraud: outrageous

Sue Doe Indianapolis, IN — Sat, 05 Jan 2008 20:12:59 GMT

The really frustrating part is often the investigative authorities KNOW that a fraud is being perpetrated by a specific provider. They let them continue their ways until they are at the place where they can make an arrest. So, instead of paying the scammers $250.000 they pay them $3 mil and maybe they are arrested but they get out on bail, use a different name get a new provider number and are back in business. Claim audit staff/ investigative teams need to suspend payments immediately until the provider can prove their services are legitimate. This also means the government has to pay for an adequate number of staff to pursue the fraudsters. The government worries too much about not offending providers because they are worried about civil litigation. It's true that "the innocent" shouldn't suffer because of the bad apples, however, experienced claim staff can generally differentiate between what is clearly fraud and what "may be" fraud. ie. The difference between billing what's not provided at all and perhaps being done but being overstated and/or overbilled. Those situations are more difficult to address in a timely manner. But claim/audit staff should have the ability to stop the payments when it is clear the payments are wrong. This power shouldn't be abused and their may be mistakes but it'd be a lot cheaper than the wait and see attitude. Also, about those returned wheelchairs - we can get into a whole discussion about what is being charged to Medicare and Medicaid for these services and look to beneficiaries being bad apples in those schemes as well. I also agree with posters that point out that the system doesn't always make sense paying too little for some important things and paying too much for other things. Can we also talk about the different branches that are involved with the claim process/law enforcement/state authorities not being on the same page...The system is BROKEN I agree.

Medicare fraud: outrageous

Sue Doe Indianapolis, IN — Sat, 05 Jan 2008 20:21:40 GMT

To the persons blaming things on Bush, this has been going on FOREVER and as to not being able to accept information concerning fraud on a loved one's card, thank you to Hillary for HIPAA. Actually, sounds like a lazy person took the call. Medicare and Medicaid can take complaints and information - they just can't verify any thing to you - not even that your relative was covered - and they certainly will not tell you if they have an open investigation on the provider that you are complaining about. But, they should TAKE information from you.

Medicare fraud: outrageous

Chas Wilkinson, State College, PA — Mon, 20 Oct 2008 23:00:02 GMT

The thing is there is alot of Medicare fraud going on, but there is also alot of medical practices and physicians being flasely accused of fraud. The bottom line is no one seems to talk about the cumbersome and inconsistent billing and coding procedures that the government has inacted. It is very difficult for even the most educated individual to bill correctly in to days world. For example, lets talk about the money the goverment spend targeting innocent physicians. You often do not hear about these cases because ther is a gag order due to the fact of patient confidentiality. But let me tell you what happens. When performing a medical exam ther are differnt points to the exam all points are tallied and with that point system you get a level of billing and coding for charge reasons. Well this is not always a science and if you ask any one in medicine they will tell you medicine is not an exact science it is an art. So say a physican ask if you have a runny nose and you say yes. He does not ask if you have a stuffy nose but puts in his chart you did not have a stuffy nose. He undergoes a medicare audit and becasue he did not ask you the specific question you are slapped with fraud case(By the way the gov has its own way of bugging physician offices). Did you think any thing of this no, you would assume becasue the nose is runny it is not stuffy, plus when the physician examined the nose is was not congested. Ther are hundred of physicinas who's carrers are ruined only to find out 5 years after repeated court cases they did not commit fraud. By then it is too late, they have no reputation and no desire to practice medicine. Why do we not talk aobut the governments waisted money in looking for fraud in the wrong places. The government is the reason health care is the way it is. They are paid off by insurance and drug companies leaving patients and physicians out to dry. I will not dispute that medical supply compaines commit fraud, but I think that this idea is the reason we have no money for medicare is insane and the government is just trying to patch the medical holes with something to distract the public. I like to know how many of these fraud cases that you saw in 5-10 year after court really prove to be valid.

Medicare fraud: outrageous

Audrey Alasia — Mon, 11 May 2009 06:21:22 GMT

There are ways to stop fraud. It is called anti-counterfeiting. Security Printing.
So much money is lost. Most of all the people who really need help are not getting it,do not let these bad apples let you focus on what they are getting away with. Many of us who worked for 23 or more years can not survive in N.Y. on $1,000. a month pay for medicare and like my Rx's $400.00 a month. Some one should do an articale on people like my self that want to work but have mult. degen. diseases of the spine. With proper help I chose work any day but at the same standard when I became ill. $50.00 an hr as an R,D,H, college grad. It frightens me to think our government may even prevent fraud by comitting fraud.They must have these anti-counterfeiting companies especially ones that have by being honest not become big corporations because they believe in what they are doing instead of the millions that can be made. Remember one journalist stated after 9/11." If these men never obtain any counterfeit documents, 9/11 never would have happened. God bless America

Medicare fraud: outrageous

Jennifer Tyler, TX — Thu, 30 Jul 2009 18:00:17 GMT

Why is the focus always on DME which makes up only 3% of Medicare spending? And anyone who thinks the government doesnt audit DME is crazy. They can show up with a badge and you have to provide all of the information. We have to provide Dr's notes that prove the Dr had a good enough reason to order it, which really shouldn't be our issue either. We are the provider of service. The dr orders it and we should just say okay Dr Smith, this is your patient and we will help them in the way you see fit. Instead we have to say, well now Dr. Smith, does the pt fit into the Medicare box? And if Dr. Smith's notes aren't good enough to fit into the Medicare box and we put out the equipement.. DME looses out. Does Dr Smith get his office visit and all of his exams that said the pt needed the equipment taken away? No. Go to the Dr and it is 80 dollars to walk in the door. There is no check and balance for the Dr's. They say they gave you a shot.. who can say they didn't? There is a code that allows Dr's to bill for Diabetic education.. and it pays like 80 dollars. So if in your 80 dollar office visit the Dr says you know you shouldn't eat as much sugar since you are diabetic, you can guarantee he just made another 80 off of you. What is the hidden agenda? The government and media is trying to get us to look left while they do something over on the right. Pay attention to what is going on and don't get caught up in what they are feeding you.