Medicare fraudsters swindle millions from the feds

Hospitals, doctors, and drug dealers have made Medicare the nation's sweetest crime, but the feds are trying to shutter the door

This slack oversight allows for glaring aberrations. In one instance, Texas's Medicaid dental program spent more on braces than the rest of the country's programs combined. But CMS only learned of it when TV reporter Byron Harris broke the story in Dallas.

Even more shocking is the case of New York state. Its centers for people with mental issues were charging the feds $5,000 per day per patient. Arizona, by comparison, charges $200 a day.

The reimbursements were based on a changing formula that CMS kept approving even as payments skyrocketed. New York's estimated overcharges: $15 billion.

Texas U.S. Rep. Sheila Jackson Lee carried water for Medicare swindler Houston Riverside General Hospital
David Ortez
Texas U.S. Rep. Sheila Jackson Lee carried water for Medicare swindler Houston Riverside General Hospital
Florida Gov. Rick Scott was CEO of a hospital company that was nailed with two sets of books. Then he went into politics.
Gage Skidmore
Florida Gov. Rick Scott was CEO of a hospital company that was nailed with two sets of books. Then he went into politics.

This time, CMS discovered the state's gouging on its own. But six years later, it's still negotiating a remedy. CMS now plans to let New York phase out its overbilling, essentially allowing the state to steal a little less each month. (CMS officials declined to be interviewed for this story.)

More obvious improvements still elude the agency — even such basics as changing a beneficiary's Medicare number when theirs is stolen or used in a fraud. Others wonder why CMS hasn't mimicked the credit-card companies, which flag suspicious behavior within minutes.

"I sent my staffer to Chick-Fil-A with my personal credit card to charge $100 of sandwiches for our office for lunch," says Burgess. "So I'm called off the floor of the House to answer a phone call from my credit-card company saying, 'Hey, someone is trying to charge $100 worth of sandwiches.' Why can't they do that?"

Obamacare has allocated $100 million to CMS to create a similar system, employing data analytics to mine for suspicious claims. The new proactive stance includes a spiffy command center in Baltimore linked to field agents. In its first full year, the system identified or prevented $115 million in fraud.

But as Burgess notes, Obamacare provided CMS with "seven new tools" to fight fraud. Four years after the law passed, CMS has managed to enact just one.

"At this rate, some point before my natural death, maybe we'll have done half of them," says the congressman.

Though most everyone agrees that the government is moving in the right direction, $100 billion continues to walk out the door each year.

"This is a lucrative business, and business is good," says Feinwachs. "The only problem is that you and I are funding it."

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3 comments
bryanflake1984
bryanflake1984

This is a horrible story.  I need to help my mom find a great assisted living center to get into.  I am super skeptical and worried about any option we make going forward.  Can someone please put my mind at ease?


bryanflake1984|http://www.altaridge.com/

mohanlon3
mohanlon3

Looks like the folks getting medicare are not the ones getting the Free Ride,.

BeenThere
BeenThere

This is the kind of article that made the underground press famous for being a resource for The Truth. When Bachmann was still being taken seriously (among circus clowns and Republicans) as a candidate for President, her regular quoting of Grover Norquist (“I'm not in favor of abolishing the government. I just want to shrink it down to the size where we can drown it in the bathtub.”) spawned a likewise saying about corporations. You know you are living in a crazy place when criminals are exalted as “job creators” and law enforcement has to go underground to get convictions of these vicious monsters before our “representatives” go to work freeing them. We are that crazy place; the United States of America.

The simple solution for all forms of government fraud is to call it what it is, “treason,” and prosecute the perpetrators accordingly. If a few hundred of these Medicare fraud CEOs were executed by firing squad a lot would change quickly. Of course the best thing about executing CEOs is that they are easily replaced, so society would suffer no net loss from their absence.

Imagine a society where the smartest people were hard at work doing something useful. We are not that place, of course, but we could have been. Without the Reagan Revolution that celebrated criminal behavior and “screwing the government for fun and profit” (also known as cheating your neighbors and robbing your community) having made getting filthy rich with criminal behavior, the nation might have become a completely different place in 2013. Instead, the ultimate scammers pick off the best brains in every graduating class, corrupting them, making them useless for real work, and wasting lives and fortune with the protection of an entire political party.

 
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