Fake companies steal billions from Medicare

C, Winston-Salem, NC — Wed, 05 Dec 2007 15:59:12 GMT

I'd like to know what the government is doing about this known fraud. Is there a specialized task force of investigators? Are we putting people behind bars? If so, for how long? Is it enough to be considered a real deterrent? What are we doing to stop this?

Fake companies steal billions from Medicare

George, Stroudsburg, PA — Wed, 05 Dec 2007 16:14:36 GMT

I would put all of those low-down bums taking from the system either at the north pole so the polar bears can have a party or in the lake for the alligators to enjoy. Catch them all right now and discard the country of such thieves and crooks.

Fake companies steal billions from Medicare

Paula — Wed, 05 Dec 2007 16:23:02 GMT

Oh I can believe it all. I don't know what Medicare is like now but approx. 20 years ago I applied for disability because of my hand, and Social Security sent me to one of 'THEIR' doctors who made me undress completely...felt every inch of my body...especially my breasts...and never even looked at my hand. All he did was ask how I fastened my bra! I reported him to SS and never heard a word about it. Of course he submitted a bill to Medicare for his services and got paid!!

Fake companies steal billions from Medicare

T. Loftus — Wed, 05 Dec 2007 16:28:19 GMT

Where are the good lawyers? I say that Muriel Sherman is a hero to be going out and confronting the thieves of our society. Now, perhaps she could find a good lawyer to work with and she could sue these companies through the court system. I would love to see a Supreme Court ruling on the bilking of the USA. No wonder the citizens of this great nation struggle with the concept of our being able to afford universal healthcare for all.

Fake companies steal billions from Medicare

Chittaranjan N. Nirmel — Wed, 05 Dec 2007 16:37:50 GMT

So why is this still kept a secret from the U. S. Attorney's office in Miami and from the Justice Department in Washington? You are just stupid if you don't know in your bones that Attorney Genaral Mukasey cares more about such crimes than he does about water-boarding and other tortures we have to use to save and protect our precious way of life!

Somebody, anybody, please call up the White house and warn them of this awful theft from the American people! I hope Homeland security or the NSA will spy on this e-mail and do it.

You'll be amazed how swiftly Resident Dumbush will call a news conference and get a massive investigation started. Those foolish left-wing, pointy-headed, pinko pundits who doubt the integrity of the Dumbush administration will then be so embarrassed . . . . Come on people, trust our leader. He cares about Social Security and Medicare. All Republicans do!

Chitta

Fake companies steal billions from Medicare

Ann, Columbia, SC — Wed, 05 Dec 2007 16:39:23 GMT

..the laws make it so easy for those to rob, kill, kidnap, rape, molest children, cheat taxpayers, abuse senior citizens...the list of crimes in the USA is endless so nothing comes as a great surprise anymore. Maybe our next President will actually do something about all this crime within the USA but very doubtful so it will only continue to get worse. Man is slowly destroying what GOD created so think about it???????

Fake companies steal billions from Medicare

Duane Abert Hadlock, WA — Wed, 05 Dec 2007 16:45:54 GMT

If the Senators and Congress people can do it whats wrong with general public taking advantage of the syestem..

Fake companies steal billions from Medicare

Craig Usas, MD; Boston MA — Wed, 05 Dec 2007 16:46:17 GMT

Deja vu cubed!
The past several decades have witnessed repeated reprises of this theme: Medicare is being bilked...Medicare knows where the bilking is occuring (yet again, Miami)...Medicare appears to do nothing about it. Perhaps the underpaid and overworked members of the US Congress might come up for air long enough to pass LEGISLATION WITH REAL TEETH. That would include - with NO exceptions - stiff fines and equally stiff jail time for ANYONE convicted of Medicare abuse. Gee, wouldn't that be an interesting event? It might even dent (or stop, God forbid) this practice about which those in the know are so knowledgeable but are simultaneously impotent to end it!

Fake companies steal billions from Medicare

Lila Jones, houston, tx — Wed, 05 Dec 2007 16:50:21 GMT

It's time for the government to hire more people to start investigating fraud claims. There's a shortage of workers who can reclaim taxpayers money. In the meantime, if the government is willing to get rid of current people in position and start from a clean slate with a decent size audit team and having state police involved then we might be able to get somewhere. It's a huge problem that is not going away and we keep saying there's not enough money in the government when a lot the money the government should have is being wasted because of lack of people to monitor and lack of intelligent plan to focus on the issues.

Fake companies steal billions from Medicare

A..J.Redlhammer- Ft.lauderdale,FL — Wed, 05 Dec 2007 16:52:23 GMT

As a person living in South Florida and also having attained Social Security age, I find this despicable. The other aspect of this (and trying to not sound like a bigot) is that the preponderance of the people that are involved in these scams are of Hispanic origin...... Not a good advertisement...

Fake companies steal billions from Medicare

Chris, Savannh, GA — Wed, 05 Dec 2007 16:55:49 GMT

Fake companies steal billions from Medicare

Nelson, Chattanoga, TN — Wed, 05 Dec 2007 16:57:57 GMT

My wife used to work for a prosthetics company that used to get a major grilling by Medicare every time they billed for a prosthetic, usually received by a diabetic. Their billings were always legitimate, but that didn't matter- they would get audited on almost every claim. Their funds could be held up for months, causing cash flow problems because they obviously have to pay suppliers and employees. I have never understood how someone with an honest history can continue to get scutinized while these phony suppliers seem to get away with false billings every time.

Fake companies steal billions from Medicare

Willy Lonetree — Wed, 05 Dec 2007 16:58:42 GMT

Just one more reason the U.S. needs blanket medical coverage for everyone. I am a Medicade patient who has needed teeth for nearly 8 years. Can't get them. They won't give them to me. Really sucks that I can't get a few bucks for some teeth because others are alowed to profit these operations.

Fake companies steal billions from Medicare

Abner Rodriguez — Wed, 05 Dec 2007 17:02:47 GMT

I live in Miami and I have seen firsthand that kind of abuse. It is a shame how many false companies are stealing from the Medicare. I have a small software consulting company. There are at least 5 home health clinics in my building. The office next to me has been empty for the last 6 months while it has a sign stating business hours and services offered.

Fake companies steal billions from Medicare

Richard Wanick, Tucson, Arizona — Wed, 05 Dec 2007 17:04:21 GMT

So what's new!

In 1979 as Budget Director of the University of Arizona Medical Center in Tucson Arizona I discovered nearly $3 million dollars in billing fraud. Thousands of pages of documentation were found in a house owned by Joe Bonano (Mafia chieftan) and supposedly 'donated' to the UofA.

I diligently brought the matter to the attention of the UMC administration, Medicare officials, members of the Arizona legislature, UofA President and Vice-president, Board of Regents and Governor Bruce Babbitt... all well documented by television and newspaper accounts.

Instead of prosecuting the crime, my life was threatened, I was dismissed by UMC administrator Dan Capps as a 'disgruntled employee', I was threatened with prosecution by Attorney General Grant Woods for managing to safeguard some of the evidence. The entire matter was 'whitewashed' by Tucson attorney Thomas Chandler with the complicity of the Board of Regents chairwoman Ester Capin.

The house supposedly 'donated' by Joe Bonano was probably a payoff to UofA/UMC officials to keep things under control; the house is long-gone but the land was developed as part of the UMC Cancer Center.

And the one thing that has always remained with me for the last 28 years is... all the differences that money could have made to so many peoples lives had it be used for their healthcare.

Fake companies steal billions from Medicare

Joe Setel — Wed, 05 Dec 2007 17:07:29 GMT

this really is, truly, heartbreaking.

as sad as it was to see the entire country pause for the death of one, great, fottball player, it sure would be nice for just a few people in DC pause whatever they're doing that more important to fix this gaping hole in our healthcare system

bottom line, where's the fiscal responsibility?

Fake companies steal billions from Medicare

Kellye, Boardman, OR — Wed, 05 Dec 2007 17:12:02 GMT

Seems to me that we need alot more alligators. This type of behavior by my fellow citizens not only embarrasses the United States as a whole, but leaves me boiling.

Fake companies steal billions from Medicare

Bob, Florida — Wed, 05 Dec 2007 17:13:53 GMT

While your examples are egregious, the other side of the coin is just as bad. Medicare's contractors label bills they don't think they should have paid as fraudulently submitted, take the money back from you by withholding payments of their already artificially low rates and you then have to litigate (administratively) with them to recover your payments. We have been in several audits with them and after interest is paid, they usually pay us more than they withheld because they are so anxious to prove fraud. Of course this increases overhead which means that those patients who are not Medicare beneficiaries end up paying more to make up for the additional cost of taking medicare. And by the way, we don't have a choice, we are mandated to take medicare by law.

Fake companies steal billions from Medicare

Linda Evans — Wed, 05 Dec 2007 17:16:19 GMT

How does an ex-biller for a medical practice report abuse? Please include that information in your report!

Fake companies steal billions from Medicare

Nick, Morris county, NJ — Wed, 05 Dec 2007 17:19:14 GMT

IS anyone going to do anything about this? Porbably not, Bush was on vacation when it happened, and will probably blame it on Iran.

Fake companies steal billions from Medicare

Steve Karn — Wed, 05 Dec 2007 17:20:38 GMT

Are we actually to be surprised at this?

Fake companies steal billions from Medicare

Gordon Beers, Almaden, PA — Wed, 05 Dec 2007 17:21:13 GMT

Nice article Mark....Now, what do we do about it.

Fake companies steal billions from Medicare

Greg, San Deigo, CA — Wed, 05 Dec 2007 17:24:26 GMT

It's called the decline of civilization. Get used to it people.....

Fake companies steal billions from Medicare

maria loughlin,miami florida — Wed, 05 Dec 2007 17:32:35 GMT

think no alligator. no permit to open this type of business if the person has no experience or is a medical profetional . medicare must call people every time they have a bill with all the sickness and problems that this poor lady show to have and don't have.
make me sick all this things that is going on and no body do anything about
thank you to let me express myself

Fake companies steal billions from Medicare

Danny Aaronson, Miami, FL — Wed, 05 Dec 2007 17:33:04 GMT

Washington already has way too much bureaucracy, however a task force needs to be established to catch the major abusers of the system using sting operations - especially here in South Florida.

The money it would cost to create the cheaters would certainly be paid 1,000 times fold in savings to the Federal (and even possibly State governments as well)in return for the investment.

Fake companies steal billions from Medicare

Leroy — Wed, 05 Dec 2007 17:41:13 GMT

And there are many financially well-off folks who see nothing wrong in transferring their personal assets to another family member in order to qualify and collect Medicare and Medicaid benefits....how disgusting! I personally know of someone who hired an estate planning attorney that advised setting up a trust in another family member's name, transferred $5 million to the trust, then declared he was financially indigent. Before he died, Medicare and Medicaid paid close to $1 million for his care. After he died, the family still had the original $5 million and the government was none the wiser! The family still brags what an astute financial planner their father was!

Fake companies steal billions from Medicare

Bil, Wash. — Wed, 05 Dec 2007 17:41:14 GMT

And the Presidential candidates want to run a Universal Healthcare system for everyone. Right.

Fake companies steal billions from Medicare

Michelle Miranda, Santa Cruz, CA — Wed, 05 Dec 2007 17:46:38 GMT

I am 59 years old, working full time with no benefits and a wage considered low in my area. I was diagnosed with skin cancer a few months ago and there are no programs to help me with medical expenses in my community. It makes me shudder to think money intended to help sick people is being siphoned off illegally for profit. As sick as it makes me when any of our hard earned taxes are siphoned off legally or illegally.

Fake companies steal billions from Medicare

Jim Jochum — Wed, 05 Dec 2007 17:48:27 GMT

What can we expect, its run by our government.

Fake companies steal billions from Medicare

G, Faulhaber — Wed, 05 Dec 2007 17:49:45 GMT

Gee, with all the "departments" in Porkville, you would think a small amount of background checking on a seedy medical supply company would be a click of the ol mouse. I am a hard working American whose insurance company canceled a policy after siting a credit blemish on a recent record. So, where are these sleuths in the Medicare program? Again, tsk, tsk government.

Fake companies steal billions from Medicare

Mario Rios Pinot, NY NY — Wed, 05 Dec 2007 17:50:13 GMT

Excellent story and reporting. It seems that the market can not regulate itself. Where are the regulators? Where are the government investigators that look into these things? Could it be that the Republicans are ok with these business people?

Fake companies steal billions from Medicare

Dr Jack Briggs....Hampstead NC 28443 — Wed, 05 Dec 2007 17:52:25 GMT

A few years ago an article came out that stated that these fake companies were paying cab drivers $ 50.00 for every medicare patient they brought into one of these "store front" medicare scams where they had the people sign up and billed medicare for services that were never provided..The money was sent to a post office box and then they could just move don the street and open another po box and keep billing under another company name...The person giving the interview stated that they were going to cut the resources of the agency investigating this problem because of budget cuts..He stated that there was 4 BILLION dollars of fraud in Florida alone..seems that recovery of a small portion of that woud have paid for a lot of investigators

Fake companies steal billions from Medicare

Ann, Richmond VA — Wed, 05 Dec 2007 17:52:28 GMT

I liveds in South Florida for 40 years. Finally left in disgust. However, medicare needs hot lines, and maybe - for huge offenders such as the ones you write about - a financial reward for turning in crooks. I saw a (legitimate mistake) double-bill on my Medicare print out once; filled out the back of the form; mailed it back to Medicare; and earned their undying gratitide, plus two thank you letters.

Fake companies steal billions from Medicare

Russ, San Jose CA — Wed, 05 Dec 2007 17:53:00 GMT

How about a bounty system? Paying informants for information leading to the arrest and conviction of the criminals might be a idea. I hat gov't bureaucracy too.. but it could be self funded by the "savings" and criminal penalties charged..

Fake companies steal billions from Medicare

H. Brumm, New Albany, OH — Wed, 05 Dec 2007 17:53:20 GMT

Just another example of the "Bush Boys" turning a blind eye to business and making a conscious decision not to enforce the law - again. Here's an idea; Bush could hire all the illegal immigrants he's allowed into the country during his two terms to investigate and clean up Medicare fraud. Two problems solved at once. Have we ever had an administration as inept and just plain stupid as this?

Fake companies steal billions from Medicare

Steve, Austin, TX — Wed, 05 Dec 2007 17:56:13 GMT

The problem here is that the real fraud CANNOT be fully investigated by the FBI. I worked at a company that offered fraud investigation models, and in disucssions with the FBI- their hands are tied by both HIPPA and Graham/Leach/Blyley act. Both make it a federal offense for them to investigate helath care information. They cannot even have the data on site. If they make the mistake of looking at it, they are subject to dismissal, and a federal investigation AGAINST them. THerefore, the ONLY source they have to investigate fraud is through whistle blowers and private tips. And since black people have the "warn a brother" motto, there tends to be very little whistle blowing within that group. Add it all together, and you find that most people think its OK to take from the government. After all, it doesn't hurt anybody individually. Until we police ourselves, and become personally responsible, and willing to report wrongdoers, we can't expect this problem to get any better.

Fake companies steal billions from Medicare

TIM HEFFERNAN, MELBOURNE, FL — Wed, 05 Dec 2007 17:57:05 GMT

Dear Mr Potter, You are johnny-come-lately on this story. About 30 years ago the fraud in Medicare was estimated to be about 29 BILLION a year. Then last figure I saw it was 55 BILLION a year and that must have been 10 years ago. So 60 BILLION today probably is low. About 8 years ago I saw a story that 3 men had been charged with bilking Medicare out of 122 MILLION. I do not know if they were convicted. You should have asked the federal caller who fought health care fraud how many investigators there are in South Florida. About 10 or 15 years ago there were only 5 or 6 and fraud then in South Florida alone was estimated to be at least 2 BILLION a year. I hope you keep on this story. It is a "national disgrace". I recall the guy getting killed by the gator a few weeks ago however I do not recall any mention that he was wanted for health care fraud. I will have to check that out. PLEASE KEEP WRITING ABOUT THIS.

Sincerely,

Tim Heffernan

Fake companies steal billions from Medicare

Michael, San Antonio, TX — Wed, 05 Dec 2007 17:57:26 GMT

It's much easier to steal from the government than a private company. The Feds kinda deserve what they're getting. This is what you get when you try to micro-manage. If medicare were fully privatized just like Part D, fraud would mostly disappear, because health insurance companies actually know how to file claims correctly. If you file a medical claim right the first time, you can detect fraud.

Fake companies steal billions from Medicare

R Joy — Wed, 05 Dec 2007 18:01:18 GMT

we can feel secure knowing that the current administration is on top of this problem.

Fake companies steal billions from Medicare

Michael, San Antonio, TX — Wed, 05 Dec 2007 18:01:23 GMT

Fake companies steal billions from Medicare

Chris, San Antonio, TX — Wed, 05 Dec 2007 18:03:40 GMT

This is exactly why we don't need goverment running social programs in our country. This is exactly what will happen if we have a social healthcare system from Hillary Clinton. Healthcare is not the problem (I know I pay for my own healthcare for me, my wife and son for less than $200 a month), the problem is the power hungry people in Washington
Chris, Savannh, GA (Sent Wednesday, December 05, 2007 11:55 AM)

So, tell explain how this "terrible & egregious" system have worked for so long in Britan and Canada? Please, don't ramble on about sooo many people don't like being taxed-as is usually the case. This is exactly what has continued to happen under the current system, so your argument is rendered invalid...boy, you had me going there for a minute, but not to be a stick in the mud, here is my political contribution. Under the Republicans, we have seen our system become so degraded that normal citizens will not even use it, instead opting to go to Canada for medications and forget about the supply side economic factors you conservatives spout, ain't working. When was there an oversupply of doctors...our "conservative" education system is now producing pastors and preachers more than it produces Doctors...but hey, Benny Hinn can reach out and heal you, no M.D. required.

Fake companies steal billions from Medicare

Dennis Smith, Houstin, Tx — Wed, 05 Dec 2007 18:05:35 GMT

I Dennis Smith wish to suggest that the Medicare agency hires bounty hunters to chase and catch fake companies and owners and operators. They are to bring them to the federal courts.. It would be wise to spend one billion dollars to the hunters for their bounty earnings in the procees of reducing Medicare fraud worth of $60 billion dollars to $5 billions bottom line. So it would net a saving of $50 billions saving to the federal budget annually.
I believe the impact of the bounty hunters' detective works and processes would interrupt and break down the fraud works of the fake companies...Why not!!!!!!!

Fake companies steal billions from Medicare

Bruce Walter, Stanton, Michigan — Wed, 05 Dec 2007 18:09:45 GMT

Im turning 65 in 3 months and I have to figur out what plan A & B are?? I trust Doctors & Hospitals about as much as a used car salesman and it is a disgrace as to how they are preying on us!!I don't know who to talk to to find out anything.

Fake companies steal billions from Medicare

Doug, Pomona, Calif. — Wed, 05 Dec 2007 18:12:55 GMT

Get real, our country has been run by organized crime since its beginning. The first theft was from the British crown of course. Then of course the colonial land was stolen from the indians to begin with. Lets face it the biggest dog wins.

Fake companies steal billions from Medicare

Pat Vince, Littleton, CO — Wed, 05 Dec 2007 18:15:14 GMT

I know of a "legitimate" doctor who lives very well "treating" the elderly and taking all the medicare payments he can. He would see many many patients during his office days, practically all on medicare I would guess. The few times I went in with one of my parents, he would check their blood pressure and listen to their heart and send them home, or in the case of my mother, order a colonoscopy. I believe my mother died of kidney failure because he never listened to her about her irregular heard beats, etc. After discovering she was in renal failure it was discovered that her heart valve was wide open. Having said all that, I believe there are many doctors out there faking the practice of medicine and getting paid by the "system".

Fake companies steal billions from Medicare

Connie, Los Angeles, California — Wed, 05 Dec 2007 18:16:58 GMT

Something similar happended to my mom. Someone she was acquainted told her to a medical clinic that would pick her up and take her there a free check-up and paid her $50. She was too naive to think that people were trying to get her medicare card number to charge fraudulent charges. It was no surprise that later she got plenty of Explaination of Benefits (EOB) reporting bills for all the medical care that she never got later. What's frustrating is that we called the fraud hotline to report all these fraudulent charges but were told by the representative on the other line that the charges were legitimate. I have no idea how the government determine the bills were legitimate when we told them they weren't. After several failed attempt to report the frauds, my mom gave up and now believes that the people at the other end of the hotline are also being paid by these criminals...

Fake companies steal billions from Medicare

Richard, Antioch, CA — Wed, 05 Dec 2007 18:18:15 GMT

If this scheme targets Medicare, imagine what would occur if universal healthcare was enacted and managed by the government! There is no way our government could keep the bad guys from exploiting universal healthcare for their own benefit. The U.S. taxpayers would take it in the shorts once again!

Fake companies steal billions from Medicare

kelly, seattle, washington — Wed, 05 Dec 2007 18:18:41 GMT

the american people don't care about anything but the next episode of america's next top model. nothing. a multi trillion dollar war, fraud, lying politicians, broken boarders, nothing.

nothing will happen, nothing will change.
ever

Fake companies steal billions from Medicare

Jane Doe — Wed, 05 Dec 2007 18:19:36 GMT

This has been going on for so long. The people in DC need to do something, not just jailtime but get the money they bilked back. this is such a big issue. They need to address it.

Fake companies steal billions from Medicare

SurenderB, Washington DC — Wed, 05 Dec 2007 18:20:11 GMT

Why are we surprised ?
Are we ?
For something like this to have gone on and at the levels it has it is obvious that the payoffs go all the way back up the feeding chain !
It will certainly take a concerted effort to change these practices starting with of course the people who are getting copies of the invoices for this purported care reporting back and denying the crooks their claims.

There is plenty of money to go around for the real problems but not enough for all of the concoted ones.
The insurance industry is also a major culprit in this game. To start with we should eliminate the insurance companies from being the middleman between the providers and patients.
Sure there are corrupt doctors but they have a lot more to lose directly and easier to tag if they committ such fraud.

Fake companies steal billions from Medicare

Leslie, Tallahassee, Florida — Wed, 05 Dec 2007 18:21:02 GMT

How does Chris in Savannah get get health care for 3 people for $200 a month?

Fake companies steal billions from Medicare

Brian McMahon, Rehoboth Beach, Delaware — Wed, 05 Dec 2007 18:24:31 GMT

We should wage war with these evil criminals. They clearly have WMC's...Weapons of mass corruption!

Fake companies steal billions from Medicare

John Skrabutenas, Buffalo Grove, IL — Wed, 05 Dec 2007 18:29:02 GMT

This is a problem inherent in the system, one in which a group appropriates money from many people against their will, and then blows that money on other people. The group has no incentive to carefully control the costs (after all, they take all the money they need), or to demand and monitory the quality (because the money is being spent on third parties). Government entitlement programs in a nutshell. I should not be paying for other people's healthcare, and they should not be paying for mine.

Fake companies steal billions from Medicare

chris — Wed, 05 Dec 2007 18:30:04 GMT

We can all shout about legislation and ask what the government is going to do aobut it...

But, the simple fact of the matter is that there are people out there who were just not raised right. Period. They have no care for the people they hurt, the lives they destroy, or the damage the do to their communites/friends/loved ones. And until such time that we as a society stand up and say NO, we will NOT allow this to go on anymore that this will stop. Until the Government and local police quit fighting over who is going to get the credit, who is going to get the extra funding that would come from breaking this case will you ever see a change in this. There will always be crooks as long as society protects them by looking the other way.

Fake companies steal billions from Medicare

Dr Jack Briggs....Hampstead NC 28443 — Wed, 05 Dec 2007 18:33:37 GMT

At least one person got it right..instead of trying to make a political statement about Republicans or George Bush he has pointed out that it has been going on for 30 years.that seems to cross many administrations and both parties....That ought to wake up everyone who is trying to politicalize the problem and maybe get everyone on board to solve it!!!!!

Fake companies steal billions from Medicare

Micha, Phoenix, AZ — Wed, 05 Dec 2007 18:36:48 GMT

Thank you to Richard Warnick for writing on this board what you have known, it explains quite a lot. There is no end of the corruption that is ALLOWED to flurrish.
I recently heard of a woman who knew that a particular doctor in a hospital where she was being treated, -spoke to her for 2 minutes, had nothing to do with her case, did not even know her file, collected from Medicare 30,000 dollars for some supposed treatment, or whatever. When she got a copy of the billing he'd sent in, she called Medicare to report the incident, but apparently Medicare gave her to understand that they were not too interested in recovering the money and really put her off from doing the extra paperwork for them to be able to retrieve it.
It was hard to understand, till now

Fake companies steal billions from Medicare

Dave,DesMoines — Wed, 05 Dec 2007 18:36:56 GMT

My wife has been a MC/MA claims fraud analyst for 8+ years, they only employed enough nurses to review 10% of the claims and they were bringing back 10 mil each per year, but...the "providers" (many of them crooked) complained to congress and they cut back on funding for fraud analysis. Nice idea?

Fake companies steal billions from Medicare

Kathryn Moody greenville SC — Wed, 05 Dec 2007 18:47:33 GMT

my goodness, it seems as if the average Joe is going to have to step in somehow and get this mess under the microscope of repair. I can only hope he/she has trustworthy friends in very high places to help, otherwise it may be just swept under the rug again.well, here goes...where do I sign up to be the first to start the new watchdog company!!!!!!!!!!!!!! I'll get it started if there is guidance and help along the way -anybody else up for the challenge?????????? let's start to make a difference for our future!!!!!!!!!

Fake companies steal billions from Medicare

John, Hotlanta, GA — Wed, 05 Dec 2007 18:48:25 GMT

There's an easy way to get around it.

THE GOVENERNMENT COULD STOP PROVIDING HEALTHCARE!!!

There should be cheap doctors for cheap people, and, tort reform. Healthcare could be inexpensive if it wasn't so regulated and messed up by the government. They ought to keep their hands out of it.

You might not beleieve it, but social programs represent 60%+ of our national budget!

Fake companies steal billions from Medicare

PAT O, HOUSTON,TX. — Wed, 05 Dec 2007 18:48:40 GMT

THEY SHOULD HIRE PRIVATE COMPANIES TO INVESTIGATE MEDICARE FRAUD AND WHEN THEY PROSECUTE THE OFFENDERS, THE PRIVATE COMPANIES WOULD GET A PERCENTAGE OF WHAT THEY HAVE SAVED THE GOVERNMENT BY GETTING THE FRAUD CLOSED DOWN. THAT WOULD SAVE THE TAXPAYERS MONEY AND INSURE SOMEONE IS INVESTIGATING.

Fake companies steal billions from Medicare

Jack Sparks — Wed, 05 Dec 2007 18:52:26 GMT

What no one seems to be getting is that there is no government official, whose job it is to do so, who is actually watching out for the American People, not from the FDA,the Consumer Product Safety Commission, the EPA,FEMA no one. They're all a bunch of incompetent Bush cronies.

Fake companies steal billions from Medicare

Deebee, Tampa, Florida — Wed, 05 Dec 2007 18:54:23 GMT

This proves that the best medical billers are the crooks. They are experts at getting paid and billing correctly albeit for phony services.

Fake companies steal billions from Medicare

Chuck, Dayton, Ohio — Wed, 05 Dec 2007 19:00:06 GMT

Maybe we wouldn't need blanket health care coverage in the US if we weren't wasting $60B annually to fraud. Think of what $1B could do in your state.

The dysfunction that produces this outcome is massive and broad and hard to tackle all at once. And despite the deficincies we have to live with, you have to recognize the complexity of the task at hand. The information load in healthcare is staggering. Think for a moment about how much paperwork and processing is involved every time you visit your doctor. Then multiply that by over 200M (lots of folks here in the USA) and use some factor for average number of visits per year and go ahead and multiply by that too... now consider the amount of information in the paperwork and processing and soon you see that there is an almost unmanageable amount of information to sift through to even get some traction and spot fraud. Couple this challenge with the regulatory environment in which states have to prosecute suspect cases. Consider the cost to prosecute and the likelihood of recovery. Remember that Medicare, like Medicaid, food stamps and unemployment compensation is an entitlement program. Once money is gone in these programs, it's really hard to get back.

Focus has to move to prevention, but in a manner that allows the system to continue to work, with some eye on response time and throughput. Good people still need care.

Oh yeah, and it's easy to see that basic business desires can get in the way. Providers want to get paid, payers don't want to pay. You don't need me to remind you of every disputed charge you've had to settle with insurance companies and the time and hassle involved. Suffice to say that there are sufficient "technical" issues that can be raised on either side to slow things down in what might boil down to a busienss really based on cash flow and what money can be made managing the float.

It's hard to condemn the entire system - it didn't get here over night and we won't see the problems resolved over night. There are many, many moving parts to address. It'll take awhile. I'd say fraudsters view Medicare and Medicaid as target-rich environments.

Fake companies steal billions from Medicare

Gary M, Redding, CA — Wed, 05 Dec 2007 19:00:13 GMT

i'm all for this bounty hunter idea. hey, we should hire Dog Chapman. i heard he's looking for something to do. and we all know how he feels about the scum living here in the US.

Fake companies steal billions from Medicare

Himanshu Shah, Parsippany, NJ — Wed, 05 Dec 2007 19:01:35 GMT

Whenever government gets involved into something, it's likely to be abused. Also, the attitude is that someone is paying for it.

Fake companies steal billions from Medicare

Laddie, Orlando Floirda — Wed, 05 Dec 2007 19:06:45 GMT

Universal Healthcare for everyone administered through private companies is the answer. Also, attach an attorney fee statute so that lawyers, on behalf of the government, can go after the fraudulent providers. Lastly, require providers to post $5,000,000 surety bonds before they can bill dime one to Medicaid. I can promise you the insurance companies posting those bonds will not take that kind of risk with questionable providers.

Fake companies steal billions from Medicare

S.P. Wiliams, Lakewood, CO — Wed, 05 Dec 2007 19:09:51 GMT

We need congress to strengthen our whistleblower laws so that anyone who snitches on these people is not retaliated against. All the really good busts come from inside, from little people fed up with corruption. And don't call if government corruption when it's private parties stealing FROM the government....

Fake companies steal billions from Medicare

j-kerr — Wed, 05 Dec 2007 19:14:40 GMT

as long as Medicare fails who cares in DC and they will not lift a finger to aid in its NOT failing its the only thing they said that could be right and they will not do a thing as long as it proves there point the ONLY thing they said would happen will happen and thats S.O.P. the way of politics! they hate to be wrong as they have been for 7 years, but this is there golden fleece, where we have to say they were right, but only due to inaction of it pilfering!

Fake companies steal billions from Medicare

Mandrake, NM — Wed, 05 Dec 2007 19:18:36 GMT

How sadly typical...the Rethuglicans get into power on the "guvmint BAD" bandwagon then proceed to fulfill their own prophecy by strangling government on the pretense of "running" it. OF COURSE Medicare doesn't work if they can't hire staff, or dedicate the necessary resources to billing fraud, quality control, etc. Why not you ask? Because the cronies that now run these departments 10 levels deep--an unprecedented sacking of professional management in favor of political cronies like Brownie who have NO EXPERIENCE in ANYTHING to do with the mission of their huge agencies--don't even ASK for appropriations in their departments (and this goes for the CPSC, the EPA, and any other acronym you can think of that has ANYTHING to do with protecting the little guy from corporate thieves and polluters).

After all, that's the point: get into power, do as much as you can to corrupt, disable and generally muck up the government agency you happen to be in charge of, then holler "LOOKY! I TOLD YA guvmint don't work!" Yeah, Brownie, it don't work when a corrupt, INTENTIONALLY INCOMPETENT moron like you and the rest of your Bush/Cheney cronies are at the helm. What a coincidence, huh??? Is anyone even stupid enough to BUY this crap anymore??? You Repubs just keep screaming about how bad universal health care and any other government "intrusion" is...history since 1980 has shown that government is FANTASTICALLY bad...when it's run by YOUR PARTY.

Fake companies steal billions from Medicare

Bob Daniel, Hopkinsville, KY — Wed, 05 Dec 2007 19:18:43 GMT

You can count on the Bush administration to straighten this mess out, just like they do respnding to natural disasters and enforcing immigration laws.

Fake companies steal billions from Medicare

j-kerr NM — Wed, 05 Dec 2007 19:21:32 GMT

they do get back what was stolen, from the patient??
the same words come to mind "who cares enough to do anything" answer no one!!! yes doctors must take Medicare, but they do not have to take Medicare patients?? and this is American from coast to coast border to border as where i live Medicare is useless and not taken, as the patient can be denied care by any doctor, but a hospital, but not the Medicare.

Fake companies steal billions from Medicare

Barbara Haynes, Cincinnati, Ohio — Wed, 05 Dec 2007 19:26:52 GMT

The answer to problem is simple. I am a Utilization Review R.N. I work for a TPA (Third Party Administratory) and I determine medical necessity. You would be suprised at the Home Health Agencies and Physical Therapy Vendors that attempt to rip of insurance companies. Guess what, when I tell them there is no medical necessity for a service, or continued service, they say, well Medicare is secondary. These vendors know that Medicare do not use RN for do Utilization Review, and they just pay the bill. I cannot begin to tell you the attempted abuse that's tried.

Fake companies steal billions from Medicare

DOUG MUSE LINCOLNTON, NC — Wed, 05 Dec 2007 19:28:05 GMT

THA USA NEEDS TO POLICE THIS ACTION AND LOCK UP ALL PERSONS WHO CHEATS OUR SYSTEM IN ANY AREA THAT INVOLVES THE TAXPAYERS MONEY. MEDCARE IS AND CAN BE A GREAT SERVICE FOR ALL AMERICANS WHO DESERVE IT.

Fake companies steal billions from Medicare

Roger Brewster, Lewisburg, WV — Wed, 05 Dec 2007 19:29:05 GMT

I am in the insurance business and I see first hand what is charged to medicare vs private health insurance companies and individuals. Medicare "we" are being robbed daily. Please call your local represenative and express your concerns. If enough people call we will see results. Medicare is a wonderful program and we need to protect it! For the people who have questions about medicare go to www.medicare.gov

Fake companies steal billions from Medicare

Leif E. Haraldsen,1834 Madison Street, Clarksville, TN 37043 — Wed, 05 Dec 2007 19:29:20 GMT

I am disgusted that this form of robbery of the public is constantly taking place, but not really surprised. I once received an outrageous bill from a large hospital, and when I contacted Medicare for an audit the reply was literally - "What do you want us to do?". It is not surprising that the criminal element tries to steal from Medicare, but is anyone investigating the continuous fraud by hospitals and physicians?

Fake companies steal billions from Medicare

Christina Raychel Janesville, Wi — Wed, 05 Dec 2007 19:29:28 GMT

There are so many scams out there. Lots of people of looking for the quickest way to make a buck. Maybe Americans will learn to stay away from tiny clinics and go to real hospitals or large, well-known clinics. Come on America, use your head. This is your health. You should check into the facilities that may one day hold your life in their hands.

Fake companies steal billions from Medicare

Nathan Ervin — Wed, 05 Dec 2007 19:34:34 GMT

I don't think it makes a difference whether Medicare is operated and managed by the Federal government or privately.The onus lies with Medicare itself. Years ago, they should have put checks and balances in place that would minimize fraud. Perhaps each medicare member should create their own PIN number similar to the system used by banks with debit card holders. We're not talking space technology here but rather implementing ways to keep the "bad guys" from taking what is not theirs.

Fake companies steal billions from Medicare

Julie, Louisville, KY — Wed, 05 Dec 2007 19:37:12 GMT

What really puzzles me is that when I worked in home health over ten years ago in Kentucky, we were audited by every agency known to man. One state auditor stayed with us for over 6 months. And yes they did find things that needed correction but we used it as a learning experience. If these empty storefronts are getting away with this, shame on us for not dealing with them. Not only do we as taxpayers suffer, there are people that need care and cant get it because they fall between the cracks.

I say it is time to get serious about these people bilking the system. The sad part is that there are legitimate companies trying to abide by the rules and regulations and sometimes very low reimbursement. Ask them the last time they were audited, I bet it was within the last year. Who is auditing the empty storefronts?

Fake companies steal billions from Medicare

harrylevine — Wed, 05 Dec 2007 19:43:34 GMT

the politicians turn a blind eye to this fraud which has been going on for decades.this is not new.the penalty should he equivalent to armed bank robbery.it is easy to catch them but everyone is looking how to rip off the system for their own benefit.heads must roll.taxpayors are maxed out.if a gov.office fails in their watch then they individually must be prosecuted.it is malfeasance

Fake companies steal billions from Medicare

Gary Charlotte NC — Wed, 05 Dec 2007 19:44:20 GMT

And just think, we want to give the US Government more our our money. This is what happens when we have the federal government in charge of anything.

Why in the name of sensibility would we want to trust the Federal Government with anything. The scary thing is the new batch of idiots running for office want more federal power, more of our money, and like the idiots we are, we will elect someone that will do it.

When will we learn. Do not vote for anyone who thinks the answer to any problem is the Federal Government. This is what we get.

Fake companies steal billions from Medicare

Alex Astudillo,North Bergen,New Jersey — Wed, 05 Dec 2007 19:46:31 GMT

Fraudulent claims are most of the resons why the government cuts benefits to those who need them.However it looks like nothing is done about it,it happens again and again.There is corruption from top to bottom within the agencies handling the benefits.The elderly and the needy are denied benefits daily because the government does not have funds to cover the increase of medical cost as financial experts swear is the problem,but it is not the cost ,it is the abuse from hospitals,physicians,pharmacies and pharmaceutical companies ,all trying to bleed the system.the question remains when to stop it and how to secure the safe use of the benefits.I am sure once the fraud is eliminated it will be funds to keep the medicare and medicaid programs providing services with less cost to the government.

Fake companies steal billions from Medicare

Les Lenzner, Poway, CA — Wed, 05 Dec 2007 19:53:34 GMT

About three years ago I went to a San Diego hospital with a cut leg. Five stitches were taken and the wound dressed. I was asked to pay $250. I pointed out that I had given my Medicare and second carrier information. Subsequently, Medicare was billed for over $1200. I protested to Medicare, but their response was that they couldn't dictate prices to service providers.

Fake companies steal billions from Medicare

MedicareAuditor — Wed, 05 Dec 2007 19:56:52 GMT

I audit Medicare and Medicaid claims for a living. I see what is reported here and worse all of the time. And, it isn't just those two government programs, it's state programs and private insurance companies, too, that are simply buried under fraud. The fix is actually simple - universal, single payer coverage. My counterparts in Sweden and Germany see far less fraud (and most of that is illegal immigrants paying doctors for care in cash. Illegal immigrants are not covered by the government programs, except in an emergency, and they are deported as soon as they are well.) In the U.S. we spend an obscene amount of money on medicare and dental care, far more per patient than they do in other countries with much better quality of care. Every day, when I see a new batch of outright fraudulent charges, when I see the "legal" overcharges by DME vendors and pharmaceutical suppliers, I am sruck by what a bunch of rubes we are. We could have true universal coverage for every man, woman, and child for about 250 billion dollars a year - no more Medicaid or Medicaid or state programs, no more wondering if your employer is going to increase the cost to you, no more taxpayer subsidized "supoer care" for public employees, no more wondering if your sick child will loose care if you loose your job, and an end to most fraud and abuse.

Fake companies steal billions from Medicare

Doug, Boca Raton, FL — Wed, 05 Dec 2007 19:56:53 GMT

Another great example of our hard earned tax dollars wasted. As a life long Democrat, I can't believe I'm saying this but I think Ron Paul needs to be president.

I'm sick and tired of our gigantic and corrupt government stealing our money and wasting it. I want to keep my hard earned money!

Fake companies steal billions from Medicare

AWP, Tennessee — Wed, 05 Dec 2007 20:05:01 GMT

What no one failed to mention is that Medicare gave these criminals Medicare billing numbers; this problem began the minute the government failed to do its job and check out the companies applying for a billing number! If the government, particularly the Centers for Medicare & Medicaid Services (CMS) had done their job thoroughly from the beginning, the great majority of these guys would have never even been given the key into the Medicare system. No storefront, no products, no store hours posted? All of those are some of the FUNDAMENTAL BASICS that are required to get a Medicare billing number. My parents have been in the Home Medical Equipment Industry for over 30 years, and I know for a fact that they work diligently to meet all of the state and federal requirements, and their company plays an essential role in our community's health care system. It is simply unacceptable for our government to point fingers at the Industry when it's really the criminals POSING as health care providers that are ripping off Medicare---AND THE WORST PART IS THAT HAD MEDICARE DONE ITS PART IN THE FIRST PLACE AND CHECKED OUT THESE COMPANIES, THEY WOULDN'T HAVE BEEN ABLE TO FRAUDULENTLY BILL IN THE FIRST PLACE!

Fake companies steal billions from Medicare

Nina Deveau, Camino, CA — Wed, 05 Dec 2007 20:12:19 GMT

Until Medicare follows other "medical insurance" providers and takes away social security numbers as the primary identification for medicare subscribers, we will, as taxpayers, always deal with some form of medicare fraud.

Fake companies steal billions from Medicare

Glenn — Wed, 05 Dec 2007 20:13:59 GMT

Sick the I.R.S on them. It worked on the mob.

Fake companies steal billions from Medicare

Neil Silverman; Framingham, MA — Wed, 05 Dec 2007 20:15:15 GMT

Bruce Walker:

AARP has a web site explaining Medicare coverage under Parts A and B.

They also explain Medicare Advantage (prescription plans, HMOs and PPOs subsidized-heavily by Medicare.)

I'm your age and I'm all set with parts A & B and Medicare Advantage; thanks to AARP.

Fake companies steal billions from Medicare

Jerry, Tacoma WA — Wed, 05 Dec 2007 20:16:27 GMT

Yeah this is our great government run healthcare. and you stupid people want them to take over it all. god help us. They can't run the VA system or the medicare system what makes you stupid people think they can provide health care for the entire country. people are so stupid

Fake companies steal billions from Medicare

Mark McKee, Albuquerque, NM — Wed, 05 Dec 2007 20:23:06 GMT

2 words.

Jeb Bush.

Good luck on stopping it, America.

Fake companies steal billions from Medicare

Pat Pather — Wed, 05 Dec 2007 20:24:36 GMT

Fly in the ointment to the conservatives - Medical insurance companies are being bilked as well!!! If this was not so, why do all of them have Fraud Investigation departments.
This is Reagan's trickle-down economy at it's finest!! And as for the market regulating itself, Hallelujah!
The beauty of the Canadian/British/German ... systems is that doctors, etc. work directly for the National Health system and are paid a REGULAR SALARY by the NHS - so the room for fraud is minimized considerably. Outside companies that provide medical services e.g. prosthetics, and bill NHS are thoroughly screened and fraud is severely punished.
Here, in the US, we spend about 15.6% of our GDP on health care; all countries with socialized medicine spend in the region of 10%. I guess the other 5.6% is for the hucksters - call it a government bonus!

Fake companies steal billions from Medicare

Peter, Issaquah — Wed, 05 Dec 2007 20:26:58 GMT

If we did what we need to do to fix this problem, the ACLU would have a fit. It's difficult to protect us from criminals and protect "our" freedom too.

Fake companies steal billions from Medicare

Mark, Cape Cod, Massachusetts — Wed, 05 Dec 2007 20:35:48 GMT

Man, i need to get into this business. millions of dollars that easily with really noone stopping you.

Fake companies steal billions from Medicare

M Johnson, Traverse City, MI — Wed, 05 Dec 2007 20:37:16 GMT

I am 65 years old and received a medicare card even though I didn't ask to be put on medicare and don't want to have medicare. Social Security told me "medicare is free, take it". Did you know that some of the cost of medicare is coming out of the Federal government's general fund? Every citizen in the United States should be concerned about government health programs and speak up.

Fake companies steal billions from Medicare

Jack McGaw, Sun City West, AZ, 85375 — Wed, 05 Dec 2007 20:42:58 GMT

This is happening all over. I found that some one had charge 6 month of rental for a special bed unsing my medicare number, as a matter of fact they also were able to collect from my secondary,(that one I have yet to figure out) they were near Yuma, and were caught because a lot of other in my area were hit. We got on the state attorny general and he caught them. However I spend many hours on this some time got no where especally when I contacted my Congress Senators. However Medicare leave them self wide open for this to happen. They have the computers or should have that would flag something like 50 people with address in Phoenix getting special bed from a place in Yuma but they don't try until congress get off their duffs and makes them do a good job. the other thing that Medicare has now done is to send out statements of the claims paid once a quarter. They use to send them our right after they paid them. Now we don't know that this is happening and can elert any one. They now do have a web sight where you can go and see just what has been charge to your number in real time.
This is costing lots and lots of money and it is time for someone to Medicare to get this right, it does not have to happen there are tool, computer programs that will prevent this but they have not up graded or don't want to.
By the way if you want to waste a good day try to get in touch with Medicare by phone. PLan to listen to lots of music and wait hours to talk to some one. Of course also they go on EST so if you live in CA you can't talk to them after 1 pm they have gone home.

Fake companies steal billions from Medicare

A Redeemed Former Villain — Wed, 05 Dec 2007 20:50:24 GMT

I come from an extended family with a predisposition for criminal activity. Granddad was a moonshiner, 2 uncles (now deceased) ran dope up from Florida, cousins running criminal enterprises and scams, etc. I sometimes plot bank robberies as a mental exercize.
So when I read this entry, the first thing that popped into my head was, "Hmmm... Easy to set up, very scant enforcement, huge returns with little risk. A little money laundering, and BAM! Early retirement!" It was the mental equivalent of the villain twisting the proverbial handlebar moustache.
Then I came to my senses. Just because I have criminal impulses, that doesn't mean I ever actually ACT on them.

Fake companies steal billions from Medicare

everyman a concerned citizen, redneck, WI U.S.A — Wed, 05 Dec 2007 20:57:57 GMT

And what have the Kings always cared about??? same old stuff, different century....

Fake companies steal billions from Medicare

zaid alam, INDIA, IN — Wed, 05 Dec 2007 21:02:10 GMT

America is a great country and people as well but few people are making it worst. For instance my case. I am INDIAN belong to very INTELLECTUAL and good family in INDIA and educated. Invested lots of money in USA but on APRIL 2007 I decided to bring my daughter 8 MONTHS OLD DAUGHTER and wife to USA for business cum pleasure trip and they have refused me to enter in USA coz they thought I will stay back in USA. I have occurred huge loses but no one is ready to listen to me. Where is the JUSTICE IN THE NATION WHO IS KNOWN FOR "STATUE OF LIBERTY"...I will continue to write emails on all the websites and write letters till I find JUSTICE. Please help me to HIGHLIGHT my case please there are lots of innocent people out there who are not CULPRITS but they are hurt from BUSH regime.

Fake companies steal billions from Medicare

kathy gallegos denver co. — Wed, 05 Dec 2007 21:03:03 GMT

Why is everyone so amazed at this, this has been going on for decades;and it continues to happen, time after time. When the government agencies should review and check people and companies they don't but when it is a legitiment thing they review and review and review and investigate till the legitiment ones are tired of the red tape,and no republicans and bush don't care, what ever happened to brother bush when he took allthe savings and loan money out of colorado at midnight, that was let go ;wasn't it, he never had to pay any of that money backto colorado.

Fake companies steal billions from Medicare

T MAGGIO, NEW JERSEY — Wed, 05 Dec 2007 21:03:41 GMT

Someone needs to ask what the government does when this is reported. All too often the reports of unscrupulous providers are not acted upon. To become a provider you are subject to an on-sight inspection, so how do those phoney stores get set up? Who issues the provider number? None other than the entity contracted by CMS. A better way might be to issue a provisional ID number and audit the first six months of business - if these are not legitimate companies then put them out of business before they bilk the program. Legitimate providers work very hard to provide needed services. It is unfair that the program has been unable to stop this activity without smearing an entire industry.

Fake companies steal billions from Medicare

Georgia, Cleveland OH — Wed, 05 Dec 2007 21:04:33 GMT

We should have a database of these thieves and never allow them to own businesses in whole or in partnership. They should never be allowed to have any kind of government license and they should have to pay every cent back. Their funds should be frozen upon the first suspicion of wrong doing and those funds should be confiscated so that these crooks cannot use them for their own defense. PERIOD>>>!

Fake companies steal billions from Medicare

Working hard 24/7 but without any coverage whatsoever — Wed, 05 Dec 2007 21:04:42 GMT

Basically, folks, there are crooks at every level of this complex enterprise euphemistically termed "medical care in the United States"...and there is no single, simple solution to the obscene loss and waste. Be aware, however, that the losses from criminal activity pale in comparison to the abuse, overuse, and wanton activity by those on "Medicaid" who have every scintilla provided and paid for them by you, the hard working, tax paying middle class who go WITHOUT substantive coverage. For example, the posting above by Willy Lonetree who apparently is bitchin* for some teeth on top of his totally free health care, food stamps, subsidized housing, and supplemental income payments. Willy, you might pawn that Lexus in your driveway, suck on your food stamps for their nutritional value, or just go back to that liquid diet of gin, whiskey, and beer...funded by the collective trillion of dollars provided by those who are hard working, tax paying members of the middle class.

Fake companies steal billions from Medicare

GS, Kansas City, MO — Wed, 05 Dec 2007 21:05:58 GMT

The real question that should be asked here is how are criminals obtaining provider numbers to bill Medicare? That is the real story. Perhaps Mr. Potter has forgotten his journalistic responsibility to dig deeper into the story. Nice fluff piece intended to incite an unknowing public's ire in the wrong direction.

Fake companies steal billions from Medicare

Matt B, Charleston, SC — Wed, 05 Dec 2007 21:06:39 GMT

And we want to give Washington more control and responsibility for providing healthcare?? If you think fraud is bad now, just wait until nationalized healthcare becomes a reality...

Oh brother. This is just disgraceful.

Fake companies steal billions from Medicare

Mrs.Watson — Wed, 05 Dec 2007 21:08:08 GMT

seems like they covered all the bases; keeping all of our hands tied...while they live wealthy lives untouched. The government in this country does run alot more than most people dare to think about...and do know how to cover their tracks.
I should know too well, I'm NDN (NativeAmerican)

Fake companies steal billions from Medicare

SoMuchCorruption, Denver, Colo — Wed, 05 Dec 2007 21:08:11 GMT

A country with too many laws becomes lawless.

Fake companies steal billions from Medicare

Civil Servant — Wed, 05 Dec 2007 21:10:06 GMT

There is a group of federal agents who are mandated by Congress to work Medicare Fraud over 75% of their time. There are approximately 300+ agents across the country who are a part of a little known (as clearly shown above by the lack of mention in the article, and in the responding comments) specialized agency primarily tasked with defending the Medicare Trust Fund.

The US Department of Health and Human Services, Office of Inspector General. They need -your- help if you are vested in working to combat this huge American problem. Support anti health care fraud legislation, legislators and the federal, state and local investigative and prosecutorial teams that fight for the time of the prosecutors.

The big problems seem to be resources, complexity and priority.

As the Medicare health care fraud experts, HHS-OIG could use triple the number of agents to work the oft times multi-hundred million dollar fraud cases. The fifty thousand dollar fraud here, two hundred and fifty thousand dollar fraud there some times is referred back for administrative action because of priority.

Medicare fraud fighting dollars are currently frozen by Congress at a fixed dollar amount a year. They can't hire more agents or more support staff because their budget is frozen.

Health care fraud can be very complex and take years of gathering evidence, reviewing records and effecting investigative operations.

Medicare rules and regulations are vast, complicated, not built to combat fraud, and run by contractors. The system needs to be standardized. Medicare beneficiaries information isn't readily or directly available to the very law enforcement officers who are working the cases, we are forced to go through the government contractor firms who process the claims submitted to the system.

Too often, prosecutors are generalists and not specialists, and few want to tackle learning about Medicare/Medicaid rules and regulations when Street Drugs, Violence (murder, against children, terrorism) and Public Corruption are easier to understand, and easier to push to the top of the pile of priority.

There isn't a single HHS-OIG agent, FBI agent assigned to white-collar health care fraud squads or Medicaid fraud control unit investigator at the state level that will disagree that certain cases absolutely need priority. But respectfully, it doesn't mean that specific, dedicated Assistant United States Attorneys in every district, Assistant Attorneys Generals in every state, and District/States Attorneys in every county couldn't be drafted into the world of combatting health care fraud. Institutional knowledge is lost too often to the private sector. We need to train up good people and retain them.

Keep up the vigilance. If you see health care fraud in your community, give the HHS OIG hotline a call (or email), give your local FBI office a call or find a number for your Medicaid Fraud control unit. We are out there, plugging away, but as many people above said it is very difficult to wade through the vastness of the health care system and 'find' fraud. We need whistleblowers, concerned citizens, in-the-know medical practicioners willing to step-up and call out their peers, their management groups, their institutions to truly begin to fight back, deter and begin to solve the problem.

Fake companies steal billions from Medicare

j-kerr nm — Wed, 05 Dec 2007 21:11:34 GMT

Medicare, Iraq, both have tons and tons of fraud and both castrate those who blow a whistle. How many trillions have been lost due to lack of accountability-less government, fire all accountants-fixed, fraud, and no one to look all for the sake of less government. Time to fire CEOs and the entire WH admin, kill there pay, and health ins when out of office as punishment, for lack of caring for we the people, pipe dream they fired the accountants so no one could see the bogus contracts, and no-bid pmts, with no action of the company! if its true with Medicare it's true with Iraq at the rate of 2 BILLION a DAY, both need to have all funds stopped and returned to await audit! to bad all i said is never to be done as it should have and never will!!

Fake companies steal billions from Medicare

Roger, Wilmington, DE — Wed, 05 Dec 2007 21:14:18 GMT

Let's back up a second...Chris from Savannah - where on God's green earth are you getting health insurance for <$200/month for THREE PEOPLE???? If that were the case everywhere, we'd sure be better off. Do tell, Chris, do tell.

Fake companies steal billions from Medicare

Sally, New York, NY — Wed, 05 Dec 2007 21:14:34 GMT

It's more complex than just arresting the bogus company CEO's. I used to audit the Sate of Florida Medicaid System and we had a terrible time trying to prosecute rampant abuse of the system and theft in South Florida. Months of investigations could be undone in moments due to legal loop holes. The crooks have the money to hire excellent lawyers.

Fake companies steal billions from Medicare

larry joe, new brunswick, nj — Wed, 05 Dec 2007 21:14:58 GMT

At least the Titanic had a band...

Fake companies steal billions from Medicare

Patrick Naeger, Perryville Missouri — Wed, 05 Dec 2007 21:21:47 GMT

This is a very sad thing for this nations taxpayers who are needlessly being ripped-off. I am a legitimate Home Medical Equipment provider who is appauled by the fact that this is alowed to go on. I believe Medicare has the tools to stop this. The data bases exist that allow careful examinations of claims and trends to sort out th fishy ones. If you have a new provider thats billed $150,00.00 in Power wheelchair claims the first couple of months in business then the red flag better go up. These claim files can be set to have flags when things dont look right. Come on lets get our act together>

Fake companies steal billions from Medicare

Lee, San Jose, CA — Wed, 05 Dec 2007 21:22:56 GMT

This story only reinforces what Michael Savage so insightfully says, "that it is a border, language, and culture problem in this "America" society of ours". Borders: because we let every stinking illegal alien come into our country and have to pay for their stinking lives? Our language: because we have to put every known language in the world on our voters ballot! Our culture: because we allow the disintegration take place of what the USA use to stand for under the judaeo-christian principles of what originally made this country great. "The love of money is the root of all evil" is true and has taken over from the government on down. Now we all are being punished and feeling the effects of greed and selfishness. It starts with each one of us to make things right!

Fake companies steal billions from Medicare

Greg Bigler Las Vegas NV. — Wed, 05 Dec 2007 21:25:10 GMT

If you think government fraud and waste is bad now, wait until the government socializes all of medicine. What is happening now to medicare will be a drop in the bucket of government fraud. Do we really want to give government more oversite of our healthcare system?

Fake companies steal billions from Medicare

Mark Elder, New York, NY — Wed, 05 Dec 2007 21:30:04 GMT

If the federal government would simply hire some trial lawyers to work for contingency fees to sue these fraudsters we could (a) put them out of business, and (b) get some of the money back. These are all RICO violations and RICO provides for civil forfeitures, triple damages and attorneys'fees.

Fake companies steal billions from Medicare

A young taxpayer who will never see a dime of Medicare, Connecticut — Wed, 05 Dec 2007 21:35:39 GMT

Don't forget all the legally owned and run businesses that ALSO bilk Medicare. I've seen advertisements for seniors to get a Lark (one of those sit-down scooters) just because they're a senior citizen. Not that they need one .. just get it because you're ENTITLED to one, and Medicare will pay most of the bill, and your insurance company can pony up the rest! This would all come to a screeching halt if someone would just privatize all of this. Each individual who has FICA and Medicare taxes taken out of their wages should go into a private account that only they could access when they retire, but that will never happen. They tell me I'll be able to retire in 2036 and if all this is insolvent by the time I get there, it's called EMBEZZLEMENT.

Fake companies steal billions from Medicare

Walt, Tampa, FL — Wed, 05 Dec 2007 21:42:45 GMT

Having worked in Medicare and Medicaid for years, I can tell you the best thing the government could do for healthcare and the American taxpayer is to get out of the healthcare business. Medicare considers being fat an illness, so glutons get medical help at taxpayer expense. The majority of Medicare funds are spent in the last 25 days of a persons life, so the taxpayers are stuck with the bill as Doctors try extreme measures to prolong a persons life wiht no quality of that life. Pregnant illegal women get covered by Medicaid for one day so that the taxpayer picks up the hospital bill for the illegals anchor children. Fraud in both programs is rampant. These programs consume a large chunk of the national budget, and the government has set themselves up as a nationalized mandated charity organization.

Fake companies steal billions from Medicare

Henry los Angeles, ca — Wed, 05 Dec 2007 21:44:18 GMT

I am very up set with the supervisors of Medicare. the are so stupid people that work there. we have try to tell them of lot of dr's that due fraud. and there respond is it will take 6 to 8 to respond. in the meentime the continue sending payment to the doctors that i told them is a fraud. the dont care. the get there salary and that is all the care. all those stupid people that work there should be terminated. all, from the top to the last person.

Fake companies steal billions from Medicare

RT, Boston, MA — Wed, 05 Dec 2007 21:44:36 GMT

Get lawmakers to fund more investigators over at the Dept. of Health and Human Services. In Boston, MA DHHS agents have recovered countless millions of dollars in the quest to knock out criminal activity. The money needs to be spent on the ground, not in the hallowed halls of DC.

Fake companies steal billions from Medicare

Cheryl, Anchorage, Alaska — Wed, 05 Dec 2007 21:48:50 GMT

Add in the doctors to this mix. I was in florida and had an operation. The hospital and doctor called my insurance agent to tell them I was on a feeding tube and had end stage ovarian cancer. I didn't and wasn't. I had a benign tumor and was walking around the hospital floor each night about four miles. Doctors and hospitals are the worst offenders. These guys are just small potatoes compared to doctors and hospitals.

Fake companies steal billions from Medicare

Mary Ann, Tacoma,WA — Wed, 05 Dec 2007 21:51:00 GMT

The Republicans and their base are hysterical about illegal immigrants and their children and the perceived financial drain on education and healthcare programs. Why do they ignore the drain on the Treasury caused by Medicare fraud and the blatant corruption by the Iraq contractors?

Fake companies steal billions from Medicare

Aaron Beaverton Oregon — Wed, 05 Dec 2007 21:56:38 GMT

This is what happens when you give the government control of health care dollars. Doesn't matter how much you give them, they'll always want more while they are wasting what they have.

Fake companies steal billions from Medicare

Susan, Durham. NC — Wed, 05 Dec 2007 21:59:27 GMT

I have represented people - mostly children- who are covered by Medicaid (not Medicare) and have seen egregious fraud by "providers" of mental health services. Essentially the state Medicaid office is paying top dollar for professioanl services to be rendered, but actually recieve lousy services delivered by unskilled,uynlicensed,unscreened, unsupervised people. When I tried to convince our state's AG's office to investigate, and even explained exactly what the fraudulent activity was, what Medicaid regulations were being violated, and provided the names and addresses of the offenders, I could interest no one.

Fake companies steal billions from Medicare

Lynn Erie, PA — Wed, 05 Dec 2007 22:00:39 GMT

I agree with Kelly from Seattle - nothing will change in this country until people shut off their constant stream of entertainment and DO something! I work in medical billing, and the hassles I get with clean, legitimate claims to medicare are just crazy.

Fake companies steal billions from Medicare

rick clark — Wed, 05 Dec 2007 22:00:48 GMT

This is a result of a incompetent goverment that sets up programs like this and dont have a way to verify were the public money is going and then as "USUAL" we here about something like this after it happens. People better wake up.

Fake companies steal billions from Medicare

Art, Coarsegold CA — Wed, 05 Dec 2007 22:06:20 GMT

What has Bush got to do with this, this has been going on for a long long time. The people who do this get caught, some of them, but the money is easy and the time isnt hard for the crime.

You want to fix this, fix the way medicare approves things and stiffen the penalties. Start sending doctors and others who commit these crimes to prison doing hard time. Id say every $1,000 your intentional steal from medicare should equal one year in prison.

Problem allevated.

Fake companies steal billions from Medicare

MC, California — Wed, 05 Dec 2007 22:06:25 GMT

As a licensed Physical Therapist Assistant, I have seen firsthand the depth of Medicare fraud and abuse in every setting. Patients are picked up for skilled services despite the obvious lack of need, treatments that were not administered were billed for payment, treatments were exteneded beyond the need.

Medicare implemented numerous changes several years ago in an effor to combat abuse and fraud. Before the new regulations took effect, we were already being trained in methods to find loopholes to obtain reimbursement.

While I understand the rationale and attempts to maintain solvency, these companies don't seem to get that the new regs were instituted because of the abuse and fraud that were already taking place.

It will take more than a village to resolve this issue. It will take an entire country. I'm just not sure that it is ours.

Fake companies steal billions from Medicare

Mike, Tacoma, Washington — Wed, 05 Dec 2007 22:06:42 GMT

I found the comment asking where are the good lawyers at to help combat this. There are good lawyers fighting this sort of abuse everyday. They are members of state and national trial lawyer associations. Of course, these are the same lawyers that are villified as ambulance chasers and crooks until you need one to fight abuse such as this. I guess it is as that point that they become "good lawyers." Maybe this incident will help bring down some of the tort deform propoganda put forth by the insurance industry for years.

Fake companies steal billions from Medicare

E WHITESIDE, PINEVILLE, LA — Wed, 05 Dec 2007 22:06:47 GMT

THIS NEWS IS SO UPSETTING. MY BOYFRIEND ACTUALLY IS DISABLED AND CAN'T GET HIS MEDICARE CARD BECAUSE THE STATE OF LOUISIANA IS APPARENTLY BROKE, PROBABLY FROM SCAMS LIKE THIS. HE IS VERY SICK AND HASN'T BEEN ABLE TO SEE A DOCTOR IN TWO YEARS EXCEPT FOR EMERGENCY ROOM VISITS TO THE CHARITY HOSPITAL.

Fake companies steal billions from Medicare

local repair man ms. — Wed, 05 Dec 2007 22:07:10 GMT

listen to this one.this is about power chairs.this company delivers the chair. they bill now the person cant get it through his or her door.now medicare. want pay for a manul chair.the company by law is to signe off saying he or she can get this chair around the house.saying he or she has a w/c ramp. guess what it takes two or more to load the d--- thing .they are stuck.this is sorry thes no goog companys do this .those adds on tv they nead to say it takes two or moor people to load this tank or u must have a crane to load it . people try tp give them to me because of some money hungry low body to get a dollar.look close befor u take or signe off on theas chairs.local repair manon power chairs

Fake companies steal billions from Medicare

AlligatorWoman, Shiner, TX — Wed, 05 Dec 2007 22:07:22 GMT

I think all we need is harsher punishment for crime! I bet any crummy thief would think twice before stealing if the punishment was getting his/her hand cut off! Have it fit the crime, like castration for rapists...and no pain killers, just let them suffer through it. I'm sick and tired of hearing about being ethical and humane, like criminals should be pampered and feel as little discomfort as possible...what about the people that they've hurt??

Fake companies steal billions from Medicare

Art, Coarsegold CA — Wed, 05 Dec 2007 22:11:12 GMT

This was no better when the democrats were in office, the way you some of you talk it just proves your a bunch of media brain washed bobble heads.

Fake companies steal billions from Medicare

Jim, DC — Wed, 05 Dec 2007 22:11:27 GMT

This is not new.... a few years ago the same scams were conducted in Houston Texas resulting in Jail time for the vendor as wellas the Doc that was involved. In Miami every Medicare provider had to reapply for a Medicare provider number as an attempt to weed out the criminals. Miami is not alone, Los Angeles is going through the same thing. The temtation is too grest when the person making the evaluation is also making the reccomendations AND financially benefits the most from the process. Medicare is in the process of stopping that process all across the country. I hope they do not through out the baby with the bath water for the actions of a few.

Fake companies steal billions from Medicare

Stewart Carter — Wed, 05 Dec 2007 22:17:29 GMT

Scary very scary ...don't people realize this money the criminals are stealing is being deducted from their paychecks .... We need to stand up for ourselves ..demand en masse this be stopped . We need to organize the people and force our government to do whatever it takes to stop this. The labor unions of the country would be a good place to begin a grass roots effort to force the resolution of this despicable issue with our government.

Fake companies steal billions from Medicare

lori castaneda,arthur iowa — Wed, 05 Dec 2007 22:18:03 GMT

i have cousins who are recieving fruadulent ssi,i have reported them and have been ignored

Fake companies steal billions from Medicare

Mary, Cape Coral, FL — Wed, 05 Dec 2007 22:18:04 GMT

And now our potential Democratic candidate for President thinks that the government should provide health insurance for all? The government needs to get out of the insurance business and leave it up to the insurers who watch where the dollars go!

Fake companies steal billions from Medicare

Stewart Carter — Wed, 05 Dec 2007 22:19:06 GMT

Fake companies steal billions from Medicare

peterc, bridgewater MA — Wed, 05 Dec 2007 22:20:49 GMT

Hail the alligator

Fake companies steal billions from Medicare

TINKER — Wed, 05 Dec 2007 22:24:44 GMT

OUR STATE AND FEDERAL GOVERNMENTS ARE FAR TO BUSY PASSING LAWS TO FINE AMERICANS FOR SMOKING CIGARETTES AND SPANKING CHILDREN TO PAY ANY ATTENTION TO ANYTHING THAT DOESN'T GET THEM ON BANNER........

Fake companies steal billions from Medicare

Rodney, Surf City, Nc — Wed, 05 Dec 2007 22:31:53 GMT

Wow think of how effecient the whole system will be once we hand over all healthcare to the government. I would liek to see a politician answer the simple question. If the government can nto handle medicare and medicaid what makes you think national health care is feasible?

Fake companies steal billions from Medicare

Tyler, Salem, Oregon — Wed, 05 Dec 2007 22:32:18 GMT

Truly, everyone, the real mistake is because of your president, George Bush.

And Everyone Knows That....

Fake companies steal billions from Medicare

Rusty, San Jose, CA — Wed, 05 Dec 2007 22:32:25 GMT

Gather up all the protected (gov't. funded) Alligators in Florida and turn them loose in Washington

Fake companies steal billions from Medicare

David Crowe Clarksville,Tn. — Wed, 05 Dec 2007 22:32:54 GMT

You people that blame the president are plain wrong. You blame the criminals that are stealing from us. If I had my way I'd lock all of them up for 20 years w/o parole.This has been going on for decades and it must stop now. I don't care how much it costs us,but we must put a stop to it NOW. I hate thieves.

Fake companies steal billions from Medicare

eb, Teterboro, NJ — Wed, 05 Dec 2007 22:35:18 GMT

To the man who pays $200 a month for health insurance for himself and his family: Buddy you better check that policy and see what it doesn't cover. I am a perfectly healthy person with normal cholesterol, normal weight, and no chronic illnesses taking no medications who is paying $9600 year for HMO coverage with referrals, preapprovals for treatment, only in-network doctors, etc. Individual health care coverage is impossibly expensive, and mine goes up in price over 20% each year. Coverage for a family where I live would cost closer to $30,000 a year.

Fake companies steal billions from Medicare

RP, DFW Texas — Wed, 05 Dec 2007 22:38:56 GMT

"Have we ever had an administration as inept and just plain stupid as this?"

Yes, more so. Check your history and put your political allegiance aside - Jimmy Carter. Why do you think this former president is so adamantly attacking a current sitting president?

Ummmm, a good place to start in cutting off this Medicare problem is checking the bank accounts of all Medicare agents involved in business dealings in that area. You think the criminals are getting this by THAT easy without greasing someone's hand? Not likely. As the old saying goes, "Follow the money, baby, it don't lie."

Fake companies steal billions from Medicare

Scared of Armendians in Southern California — Wed, 05 Dec 2007 22:39:34 GMT

I live next to a couple of Armenians in the San Fernando Valley who do the same thing. They drive around Mercedes and in 4 years of seeing them they have never had a front bumper plate, the law in CA, on these Mercedes. When they do their barbecues Guido's abound. Also they got welfare checks accidently delivered to me and they live in a 400K home (what is was worth when bought)

How they get away with it day in and day out I don't know.

Fake companies steal billions from Medicare

Ryan, Dallas TX — Wed, 05 Dec 2007 22:40:51 GMT

Yeah chris, universal health care works sooo well in Canada. Waiting hours to see a doctor, and waiting weeks or months to get surgery. Sounds fantastic to me. Drugs are cheaper though, but thats only because the Canadian government madated that they can only charge for the cost of the drug, not more to fund more R&D. Also, maybe the Canadian systems works so "great" because maybe they are 10% of the size of the US?

Fake companies steal billions from Medicare

Jack K. — Wed, 05 Dec 2007 22:42:11 GMT

Yet another reason for universal healthcare. They don't have these problems in Canada, Britain, or France.

Fake companies steal billions from Medicare

Al, Hilton N.Y. — Wed, 05 Dec 2007 22:42:14 GMT

Well, do you think the feds would spend a billion dollars create jobs to track down these frauds!!!
Spend a billion to save 60 billion. Do the math.
Just think, you could create a few hundred jobs with this. I know it would be too much to ask. Would it?

Fake companies steal billions from Medicare

Tim — Wed, 05 Dec 2007 22:46:05 GMT

Another reason universal health care would fail. There'd be even more of these people out there just stealing from the government. There are enough laws out there already to take of these people, it's the liberal judges and prosecutors that just let these people walk. We need more jails, would you support a new tax for jails? My home town just waisted 15 million on a football stadium but would only pay for a single prison cell for the town. Seems the town priorities are way off the mark. People complain all the time about crime, when was the last time you did anything about it? Stop passing the buck, you see it happening, do something about it!

Fake companies steal billions from Medicare

Roy J. Meidinger, Fort Myers, Florida — Wed, 05 Dec 2007 22:46:06 GMT

This link will lead you to newspaper story about how the IRS is going to audit all secret contracts between hospitals and health insurance companies. There is further documentation included in the links provided by the newspaper.

There is a popular belief, even vaguely stated in the newspaper article that insurance companies somehow purchase a lot of operations or services from the hospitals and then sell them to their policy holders and that is why they are given such huge discounts and do not have to pay the full amount billed to the patient who is their policy holder. The insurance companies are not the customer of the hospital and therefore not entitled to any kickback, the insurance company is only a third party payer. As pointed out in the article by an industry spokesperson all private pay patients are charged the same price and therefore the hospital must collect the same amount for the same services, no matter what methodology the patients use to pay. If it legitimate discount is given to the patient and it must appear on the patient’s bill. By not collecting the amount billed to the patient from the insurance company the hospital is given the insurance company a kickback. In the pass seven years Lee Memorial Hospital has given 873 million dollars to the insurance companies; the purpose of which was to have the insurance companies force their policy holders to the hospital. Neither the hospital nor the insurance companies are reporting these secret kickbacks to the government and both are participating in fraud. The insurance companies do not pass the benefits of these kickbacks on to their customers, the employers who pay the premiums for the insurance policies.

The second point as stated by the defense attorney there were several law cases dismissed by the courts, prior to 1999. It was a common belief the insurance companies were exempt from the antitrust laws. This belief had its origins created by the McCarran-Ferguson Act. The majority of people in the industry believe the industry was exempt while a minority, like me did not believe they were exempt. In 1999 the Supreme Court, in its ruling on Havana v. Forsythe settled this question. Its interpretation said the insurance companies could be exempt if a State's legislature passed a law making them exempt and substituted their own restraint of trade laws. In the fifty states not one state legislator has passed any law making the insurance companies exempt from the Antitrust laws but in fact 40 of the states have passed legislations making the antitrust laws more restrictive, particularly the Robinson-Patman Act, by increasing the definition of a commodity to include services, or products derived from services. So since 1999 both the hospitals and the insurance companies must abide by the antitrust laws and cannot commit any practices which might be construed as Brokering, Price Fixing, Price Discrimination, Boycotts and especially tax evasion.

This is an excerpt of a legal brief I have filed with the court about some of the activities of administrative groups to correct the problem:

2) I do not believe there is in Lee County or the United States any informed individual who does not know that most hospitals, Lee Memorial Hospital included, do not collect the same amount of money for the same services provided to the un-insured private-pay patients as well as the insured private-pay patients; but, in fact they do bill the same charge, for the same services. Price being defined in Black’s Law dictionary: “as the amount of money given or set as to be given as consideration for the sale of a specified thing”. If the hospital does not collect the same amount it is Price Discrimination, which Black’s Law dictionary defines as: “Exists when a buyer pays a price that is different from the price paid by another buyer for an identical product or service”.
3) In my investigation of the hospitals which belong to the Medicare program, I found 81% of the hospitals do collect different amounts then are billed to insured private-pay patients while 19% of the hospitals actually collect the same amount they bill, from both insured and un-insured private-pay patients. I further investigated with interviews as to why the difference was allowed and was told the insurance companies were exempt from the antitrust laws and could get secret discounts. I went further with my investigation as to why this belief and practice was so widespread and was finally told by two different lawyers, who specialized in antitrust law; it is because of the McCarran-Ferguson Act passed by Congress. This act, originally passed to cover insurance insolvency, was so vaguely worded that it seemed to exempt insurance companies from Federal Laws, like the antitrust laws. Two groups were formed, the majority of which believed the insurance companies were exempt from the antitrust laws and the minority, me included, did not believe they were exempt.
4) In 1999 the Supreme Court answered this question about the McCarran-Ferguson Act, whether the insurance companies were or were not exempt of the federal laws in the Havana inc. v. Forsyth, 119 S. CT. 710 (1999) (Humana) case, this case dealt with the RICO Act, and is not normally searched for in cases dealing with the health care industry, but is relevant to this case. The Supreme Court said the insurance industry could be exempt if the state they were dong business in passed laws saying they were exempt and also passed laws against restraint of trade. I have done a search of all fifty states and found no state has passed any law saying the insurance companies are exempt of the antitrust laws but to contrary found forty states which have made the restraint of trade laws more stringent, especially the Robinson-Patman Act, where in a commodity now includes in its definition the term service or product derived from a service.
5) So prior to 1999, the majority of people, including lawyers and jurists could believe and many acted on those beliefs, that the insurance companies were exempt from the antitrust laws. All my previous cases were filed prior to 1999. This case was filed in 2006, so we must look to see if the consideration given by the hospital, in the secret contracts is for a legal reason, and not some practice which might be construed as brokering, price discrimination, price fixing, boycotting or tax evasion. I have read some of these contracts and know they are not legally enforceable.
6) The second practice I found among the hospitals who did not collect the full amount billed from the insurance companies was the accounting practice of writing it off to a “contract allowance account” or “contract adjustment account”. When I interview federal and state auditors they said the contract adjustment account had to be used for government programs in order for the hospital to balance its books, between what is billed to the government, the customary charge, and what is actually collected from the government. When I asked them about the private side of the hospital business they did not audit the private side of the business but assumed since it was being done for the government programs it must be okay for the private side of the business. These individuals were not trained in the law. They did not know there are different laws governing the government programs and the private side of the business.
7) Why administrative group activity is related to this case
8) Local Rule of Civil rule 1.04(d) says that any proceedings by an administrative group which have a bearing on the case should be reported. The Relator has submitted to the court a list of contacts and administrative groups who he has forwarded information and complaints to and which he believes he was responsible for causing actions:
A) The Internal Revenue Service was give a list of 2786 hospitals, hospital chains and insurance companies whom the Relator believes is practicing tax evasion. The IRS took a survey of over 500 Not-For-Profit hospitals, of those named and determined the hospitals were indeed actually billing both the private-pay insured and the un-insured patients the same amounts for the same services but was not collecting the same amounts. The IRS said for a person on the accrual method of accounting, the revenue is recognized when all events have occurred to fix the right to receive the income and that the amount can be determined with reasonable accuracy. The face amount on the patient’s bill can easily be determined, so the revenue is to be recognized. If a legal discount is given, the net amount is to be placed on the bill at the time of issuance, so the recognized revenue is the net amount to be collected, but no discount is ever posted and the face amount on the patients’ bills never change.
B) The IRS wanted to know why and for what purposes the consideration was being given to the insurance companies. If the contracts were not legally enforceable, the amounts written off as “contract adjustment” or “contract allowance” were to be put back on the books and then handled in the prescribed manner as required by law.
C) The millions of dollars and thousand of man hours to be spent by the IRS auditors speaks volumes of the seriousness of this endeavor. If I am right, both the hospital, even if tax exempt and Not-For-Profit and the insurance companies’ will have to pay trillions of dollars in taxes. In 2008 I predict because of the IRS audit the practice of given secret discounts or kickbacks to the health insurance companies will stop and all private pay patients will be charged the same and have the same amount collected.
9) With information provided by the Relator to the Health and Humane Services, The Centers for Medicare and Medicaid Services, Congress and the Federal Reserve, I have identified a major flaw in the old method of determining reimbursement rates for services provided to the Medicare and Medicaid beneficiaries. HCFA, now CMS made an initial cost study in 1982, for determining the reimbursement rates of the Diagnostic Related Groups. Then every year since then they relied on the charges listed on the beneficiaries’ claims to make a determination of the amount of the reimbursement rates. These charges listed, they believed were the actual amounts collected from the private pay patients, known as the “customary charge”, were the fair market value of the services provided.
10) With the cooperation of HHS and Congress the General Accounting Office made an audit of 1025 hospitals, determined under the old Charge-to-Cost methodology Medicare was over paying by 39 percent and by utilizing a new methodology of determining reimbursement rates both Medicare and Medicaid will be paying 28 percent less. The million of dollars spent in developing a new methodology and the thousands of man hours spent doing the audits speaks volumes of the seriousness of the problem. I predict that in 2008, with the customary charge no longer being utilized to make a determination of the reimbursement rates, the industry will stop trying to inflate the customary charges and go back to collecting the actual amounts billed to the private pay patients. In the past if the industry could not lower the customary charge because the reimbursement rates of the Medicare and Medicaid rates would also drop. So with the customary charge out of the picture, the hospitals can role back the rates and it will have no effect upon the reimbursement rates.
11) The hospitals have to sign a certification each year that they are in compliance with all laws. The stark laws deal with self referrals in the health care system. To this end the Centers for Medicare and Medicaid Services told the hospitals to get rid of all their physician groups. All the hospitals have spent hundreds of millions of dollars purchasing doctors practices, so the doctors would send their patients to the hospital. Due to the fact that CMS has issued this directive the hospitals must try and sell these practices back to the doctors, or lose their investment. Since it was illegal for them to purchase the doctors practice in the first place I don’t care if they lose hundreds of millions of dollars. The import thing to remember is that during the period of time, outlined by this court case, Lee Memorial Hospital was in violation of the law and therefore in violation of the Social Security law covering the Medicare and Medicaid programs. The Stark law is also considered a restraint of trade law.

Fake companies steal billions from Medicare

Cathy, Belleville, Illinois — Wed, 05 Dec 2007 22:47:26 GMT

When Gov't Officials can retire and keep their salaries as if working and still draw Social Security, well, who is doing the abusing? I don't condone whats happening but come on, lets start at the top and not let them get buy with this as well as those who cheat and have been caught.

Fake companies steal billions from Medicare

John Doe, Seattle Wash. — Wed, 05 Dec 2007 22:53:27 GMT

I think someone should find these businesses, stake them out and then shoot the people runnung them.
It would be easy to do.
The law and government could do nothing because they're so hand tied and slow to react.
We could take out 30 to 50 of these sites in less than a week and save the taxpayers hundreds of thousands of dollars.
These people arn't worth anything more or less.

Fake companies steal billions from Medicare

Lee S. Benson AZ — Wed, 05 Dec 2007 22:57:18 GMT

They don't mention the so called up standing doctors who do not fall in the catagory of flake companies that are milking medigare for every penny they can get. that is worse than the fake companies. ( I don't intend to run down the good ones, but they know its happening).

Fake companies steal billions from Medicare

Bill , Dallas, Texas — Wed, 05 Dec 2007 22:57:47 GMT

Just remember, the Democrats want the Federal Government to run ALL Healthcare, not just Medicare.

Be afraid, be very afraid......

Fake companies steal billions from Medicare

K-Luve Boulder Co — Wed, 05 Dec 2007 22:59:18 GMT

OH PLEASE, Nothing will be done! Our Gov is in on the entire thing. and yes Bush will blame on someother Country that we an clearly beat the crap out of. Now while Bush is drying his muf taking kick backs from oil and Medical,, He want saying anything.

Fake companies steal billions from Medicare

Burbank, Ca — Wed, 05 Dec 2007 22:59:45 GMT

I am good friends with a fraud medicare Doctor.

Yes, they bring in bus loads, yes they bill for millions, and they were never checked out, not in 6 years atleast.

Fake companies steal billions from Medicare

Cash Nwachuku, St Paul, MN — Wed, 05 Dec 2007 23:03:21 GMT

So Medicare can be defrauded? I did not think they could lose money to crooks because each time I billed Medicare, they asked for doctor's prescription, patient's signature, proof of delivery, etc.,. Medicare ran me out of business after four years of hard work, and honest business practices. They never paid any of my claims on time, so how come they paid these crooks whenever they submitted bogus claims? The system is simply broke, and I am mad as hell!

Fake companies steal billions from Medicare

mike small — Wed, 05 Dec 2007 23:07:40 GMT

whats the big deal, if we didnt have crooks and thieves, than, what would our leaders have to do, we need them as much as they need us. its like the war on drugs, some always get threw the wire, others see that theres no one watching and they start their own business. some get cought, everyones happy.

Fake companies steal billions from Medicare

Evelyn Woodson Florida — Wed, 05 Dec 2007 23:16:28 GMT

This problem is the same as blackwater and other pro tected theives ,On Federal payrolls is the silent partners who is allowing this abuse to take place, My Son has suffered 32 years with Brain Cancer, and denied any help, He is uable to work, But because he fear being jailed again for back child support, he is now going to risk working asa a cook where he will be at risk he has seizurs and no doctor to provide follow up care sine he had a nine hour brain operation, I wonder what kind of Nation America realy is, The cold blooodness of power mongers is very serious, This is the same in Iraq now.

Fake companies steal billions from Medicare

Eric, Morristown NJ — Wed, 05 Dec 2007 23:17:03 GMT

I'd be interested in finding where the figure of $60 annually in fraud comes from. Aritcles I've read seem to throw out numbers without giving any documentation for them. This author certainly doesn't.

That author DID cite a name (and presumably source) for information on the South Florida enforcment efforts, where the FBI has 27 agents assigend to the two-county area.

In another article (http://www.npr.org/templates/story/story.php?storyId=15178883) the author first says that in the $368 billion program there is fraud of $35 billion "or more," and then later speculates that IF fraud is at 20%, the figure would be $70 billion annually. Again, he doesn't cite a source. All too often one reporter's speculation (eg, the $70 billion) becomes another reporter's "fact."

Oh, yes, and there already is a 'bounty' system whereby whistleblowers receive part of the money recovered (as reported in the aforementioned report).

Is the government doing anything about this known problem. The answer is yes. Please read this report: http://www.taf.org/MedicareFraud040805.pdf.
Over five years (1999-2003) at a cost of $409 million, the federal governemtn recovered $5.2 billion, a return of $13 for every dollar spent.

I have no idea whether medicare fraud is at 10% or 20% or some other number. I suspect that if, at the currnet level of expenditure for enforcement, with a return on that expenditure of 13 to one, an dthe amount recovered annually is less than half a percent of the total Meedicare budget, there is a heck of a lot more that COULD be recovered (with perpetrators going to jail) before there is sufficient deterent value to minimize this crime.

So kudos on the efforts already made on Medicare fraud enforcement, but let's have a lot more of it!

And reporters, PLEASE cite the source of key 'facts' so that a reader has a chance to evaluate the information.

And finally, we ALL need to care more and become informed about such important matters (more important than sports scores, Survivor, American Idol & the like).

Fake companies steal billions from Medicare

dotherightthing, Flint, MI — Wed, 05 Dec 2007 23:19:32 GMT

In Fenton, Mi an Accountant paid back $1 million to medicare because a clerk at his medical practice filed a whistleblower suit against him. He did this "voluntarily" and there were no criminal charges filed against him. It is sad that only poor criminals go to jail and white collar criminals can just promise to pay back the money they stole and avoid jail time.

Fake companies steal billions from Medicare

J Blumenthal — Wed, 05 Dec 2007 23:22:57 GMT

Chris from Savannah gets healthcare coverage for his family for $200! Where?

Chris, you must be 25 and healthy. What you will find out as you age and more infirm is that healthcare insurance by for profit companies is designed to be affordable to people who don't need it. Michael Moore is absolutely correct in saying healthcare insurance should no more be controlled by for profit companies than fire fighting!

Fake companies steal billions from Medicare

Lisa Cousins, Geneseo, IL — Wed, 05 Dec 2007 23:23:09 GMT

First of all, this is why we don't need more government in our lives. Government does not run efficiently. Secondly, I'm tired of hearing people blame the insurance companies. Go read Robert J. Samuelson's article in this week's Newsweek. People need to be responsible for their own healthcare.

Fake companies steal billions from Medicare

robert pfeffer irvine, CA — Wed, 05 Dec 2007 23:25:09 GMT

if you have a valve in your heart "wide open" you would not be able to walk to the doctor. If the doctor listened to the heart the murmur would be loud enough for you to hear.

Fake companies steal billions from Medicare

robbie johnson, altadena, california — Wed, 05 Dec 2007 23:27:54 GMT

it is a fraud perpetrated by the government upon the people. The laws are passed and then the departments are not given the funds to hire the agents to combat the fraud.there r approx 10 agents for so caLIFORNIA.
i know because i worked undercover for medicare.
Those who know r sitting back laughing at the ignorance of the people.

Fake companies steal billions from Medicare

JOHN LEWIS, EMMAUS, PA. — Wed, 05 Dec 2007 23:29:41 GMT

I am not shocked at the fraud, since fraud has been occurring in probably every federal/state program that
dispenses money from time beginning. Almost no difference between Medicare fraud and the private security contractors in Iraq, I believe $100 Billion.
The key question in all of these programs is, who and
where are the Gatekeepers? Why are there not SEVERE
prison penalties for both Medicare fraud as for the
Contract Supplier who charges $600 for a toothbrush and $1500 for a toilet seat. Medicare is fragile
financially for the multitude of Seniors who depend on
it, so I find it outrageous that effective gatekeeping
is obviously not a key component of govt. management.
A hugh taskforce of gatekeepers is needed, and since
this is "government" managed, only mediocrity will
prevail. Not defeatist, only realist.

Fake companies steal billions from Medicare

carlos robles El Paso Texas — Wed, 05 Dec 2007 23:29:45 GMT

This makes me sick to my stomach!!!!! and not only medicare,but also medicaid especially in the border city of El Paso,Tx I see it every day people living in Juarez across the border and yet they come to see the doctor with "medicaid"..Whats wrong with our system and what makes it worse is that they get away with it,and its costing "US" the taxpayers....they should all be giving them to the crocodile's.....

Fake companies steal billions from Medicare

robbie johnson, altadena, california — Wed, 05 Dec 2007 23:30:03 GMT

Fake companies steal billions from Medicare

scott, farmington, nm — Wed, 05 Dec 2007 23:30:14 GMT

The solution that no one is suggesting...
The goverment shouldn't provide health care for anyone. (except maybe the kids).

The only thing goverment should do is make some type of health coverage available to everyone to buy.

When did our society begin to believe the government should pay for everyone's healthcare. Our society is slowly becoming the socialist country that we despised not too long ago, and right now we are really close. Up until now, we have been able to function with budget deficits because there was a huge reservoir of money in the social security trust fund; but now that money will be depleted and the crooked politicians will have to "fix" the systems by raising taxes. The real solution is to do away with the benefits, and make people get a job if they want insurance.

Fake companies steal billions from Medicare

Joseph Entwistle — Wed, 05 Dec 2007 23:31:14 GMT

It's stories like this--true or not--that give us small, independent medical supply companies a bad name. BTW, Medicare is quite vigilant about recouping money for claims they think are billed in error, whether they were or not.

Fake companies steal billions from Medicare

Raymond e st. pierre woonsocket Rhode Island — Wed, 05 Dec 2007 23:35:36 GMT

I fell off a ladder about 2 years ago.broken leg and 2 crushed vertebrae in my back. I received bills from 2 hospitals.woonsocket hospital and Rhode Island hospital.asked for an itemized bill from both.amazed how much they padded the bills I said I would file medicaire fraud complaints.amounted to thousands never heard from them again.what does that tell you.

Fake companies steal billions from Medicare

K. Dean Durham N.C. — Wed, 05 Dec 2007 23:38:19 GMT

The overall effect of medicare fraud has been to make it extremely difficult for real patients with real problems to get services. Its not that medicare hasnt bothered to do anything about fraud, they have. The amazing amount of leg work that has to be done by a patient to get medical equipment such as oxygen is dangerous. Even if all paperwork is done properly the first attempts at billing for just about anything are usually denied. I work in the medical equipment field and have devoted my life to providing legitimate equipment to people who actually need it. I have never commited any type of medicare fraud. The one question that I would like to see addressed is the difference between actual theft of medicare funds i.e. false claims, false patients etc etc, and what medicare calls fraud. Almost anything that is denied by medicare can be clasified as some sort of fraud i.e. the patient put the wrong date on an invoice and that mistake is missed and submitted for billing purposes...fraud. Medicare has a very complicated code defining medical necessity that promotes mistakes that are often counted as fraud. Are these numbers counted the same as with actual theft? I hope not. I think it would be intersting to see how much money medicare takes back from legitimate businesses who have made minor paperwork mistakes through their auditing system.

Fake companies steal billions from Medicare

R Williamson — Wed, 05 Dec 2007 23:42:28 GMT

This is OUTRAGEOUS! AND unfortunately, this and other such schemes have been going on for DECADES. For those who want to blame Bush, what did Clinton EVER do about it?The problem is that the government is TOO BIG, too many programs, too many layers of bureacracy and there is NO ACCOUNTABILITY to anyone. Medicare/Medicaid depends on funding from CONGRESS to operate. Seems to me that's where the investigation, oversight and elimination of this problem needs to be handled. The honest, hard-working American citizens need to stand up and DEMAND that this problem be addressed. Nothing will ever be done about it until the people MAKE them do it. Write and call your senators & representatives. Why do so many of them go to Washington with average amounts of money (e.g.Harry Reid),and then retire as millionaires? Dishonesty, cronyism and pay-back is too rampant in our government. We have to start putting pressure on our own representatives and hold their feet to the fire. Unfortunately, not enough people have the time or the guts to do this. AND so it goes on and on. Meanwhile, our country is being ruined by this sort of dishonesty and greed.

Fake companies steal billions from Medicare

Bill Waddell, Helena,MT — Wed, 05 Dec 2007 23:43:38 GMT

If you have ever tried to report fraud you will be in for a SUPRIZE. MEDICARE has no fraud hotline, no way to write them or contact them. When will our lazy a--ed elected officials get off their cans and do something.

Fake companies steal billions from Medicare

james ziegler, westlake village, CA — Wed, 05 Dec 2007 23:43:53 GMT

And the American people are being duped into believing that the Federal Government aka "Nanny State" can provide 300 million US Citizens with universal health care?????

Fake companies steal billions from Medicare

Brennen G, Kansas — Wed, 05 Dec 2007 23:46:26 GMT

As a legitmate provider of home medical equipment it makes me furious when I read about fraud in our industry. We face Medicare cuts to the DME program every year and we have become more effecient to weather these cuts. It's disheartening to think that I'm cutting staff so a guy in Miami can drive a Bentley and own yacht. We provide a great service to hundreds of Medicare beneficiaries and our industry saves ER visit, hospital stays and nursing home costs. The OIG needs to target fraud without punishing the good guys. The money is there it's just in the wrong place.

Fake companies steal billions from Medicare

Pat Reardon Castleton, NY — Wed, 05 Dec 2007 23:50:17 GMT

This is a disgrace. My mother spotted at least two charges for prosthetics from companies on the West Coast charged to her Medicare Number on her EOBs. She never had any such medical devices and has never heard of the companies. She tried to address this with the Medicare people and she got nowhere. The system is much worse than broken and we are all paying through the nose for it!

Fake companies steal billions from Medicare

Marilyn Burton Payette, Id — Wed, 05 Dec 2007 23:56:47 GMT

This is a bad situation, but you Bush haters, this has been going on long before Bush came to office. You would think that by now, somebody would have some kind of a clue to getting this problem taken care of. Maybe private investagters could do a better job.

Fake companies steal billions from Medicare

Cathy — Wed, 05 Dec 2007 23:56:51 GMT

This whole thing makes me sick. My mother is on SSI and Medicare. She doesn't not have any income at all. She has worked hard all her life and is a honest tax payer. She is barely keeping her head over the water She get very little. Just enough to pay her rent. She has nothing left for medical bills, medication or for Necessities such as food or clothing. They keep cutting her income and benefits. She is a afraid she will end up on the street. I'm on a fixed income myself and unable to help except moral and emotional support. When she tries to get more help, she is told she is not eligible. Something is very, very wrong. Why are so many getting away with fraud!! And others are suffering. People are getting rich at the expensive of others and that is just plain greed and selfishness.

Fake companies steal billions from Medicare

Linda S, Albuquerque, New Mexico — Wed, 05 Dec 2007 23:58:27 GMT

It really amazes me that the United States, considered to be the last superpower, cannot control the spending of tax payer dollars. This scenario is played out over and over again. We've all heard the stories of how we "lost" or "misplaced" billions of dollars in Iraq, New Orleans, through Medicare Fraud, government contractor overcharges (Haliburton) and don't forget the golden toilet. Can you imagine how much of this money could be used to reduce the astronomical debt and help AMERICAN'S? This should be the number one priority of ALL our government officials. This is not a political party issue. This is a crime and it hurts all of us. We need to put our differences aside and fix the problem NOW! Can you imagine just voting for the person and NOT the party? Interesting concept.

Fake companies steal billions from Medicare

gasdok — Thu, 06 Dec 2007 00:03:57 GMT

Meanwhile, real doctors and facilities struggle to even get enrolled.Several doctors in my town are facing closing up shop after waiting a year after providing services,for the privately owned medicare intermediary for Florida to get the kafkaesque paperwork approved.This is an absolute nightmare in Florida and could use some government investigation and intervention.

Fake companies steal billions from Medicare

Jim, Coxsackie, New York — Thu, 06 Dec 2007 00:07:28 GMT

Perhaps Medicare should actually visit entities requesting Medicare provider numbers. Perhaps Medicare should verify proffesional licenses, leases, medical credentials, addresses, criminal background checks, etc BEFORE they issue a provider number which allows providers to bill on an "honor system". Imagine if the government VERIFIED the information on a provider application before they allowed the provider to send in a single bill. Imagine. Perhaps the government should require mandatory accreditation of entities requesting a provider number.
You can't walk into a bank these days and withdraw money without two verifiable forms of ID. Currently, many providers need only submit a paper application via mail to get the "keys to the cookie jar".
There are many many many legitimate providers of healthcare services doing a fine and honorable job taking care of our seniors. Then there are the bad actors. With a little effort, CMS could root out much of fraud before it begins if only they would do a minimal amount of due diligence verifying the data submitted on an application BEFORE they hand over that provider number. Unfortunatly, the goverment body responsible for overseeing the distribution of Medicare funds is "asleep at the wheel".

Fake companies steal billions from Medicare

Steve Adams — Thu, 06 Dec 2007 00:08:45 GMT

There are so many questions that seem to keep cropping up...questions that surround Michael Chertoff who legally represented a person of interest in New Jersey who was alledged to have been stealing federal dollars from Medicare in NJ...Chertoff was at the time the AG but handily represented the Egyptian doctor for several years. Chertoff also was key in writing the Patriot Act in 2001. too many question marks...

http://prorev.com/2007/08/michael-chertoff-unconstitutional.htm

Fake companies steal billions from Medicare

bob rathbun,quartzsite,az. — Thu, 06 Dec 2007 00:20:27 GMT

put a bounty on them. might not slow the crooks down,but the bounty sure would. just hang them on a fence like a coyote.

Fake companies steal billions from Medicare

Huma Suffrana, Queens, NY — Thu, 06 Dec 2007 00:28:06 GMT

We can see what the problem is: a system that practically invites unscrupulousness. Passing more laws or putting more auditors on the case won't help. They'll catch some of the crooks who have been stealing, but even if they lock up said thieves and throw away the key, new thieves will take their places. It all reminds me of the so-called Wars on Drugs and Terrorism, which actually perpetuate what they purport to fight.

Fake companies steal billions from Medicare

don riley — Thu, 06 Dec 2007 00:50:09 GMT

They need to hire a coupla hundred investigators. The money they save would more than pay their salaries and Medicare would be way ahead!!

Fake companies steal billions from Medicare

Frank Meulenberg, Port Charlotte,FL. — Thu, 06 Dec 2007 01:02:00 GMT

My father was at a nursing home in Homestead, Fl. (Dade County) for a few months after Hurricane Charley. We moved him back closer to home after rebuilding. A medical supply company is still charging medicare for a wheelchair rental over three years later. I called medicare and talked to a lady there who did'nt seem to care. After trying to get her to do something about it to no avail, I told her look lady, you, I, and everyone else are paying for it. I finally hung up on her because she did'nt want to hear about it.. We are talking about thousands of dollars. I applied for disability five years ago. Back surgery and was born with club feet and had five surgeries for that and am in constant pain, but I get denied. Burns my arse.

Fake companies steal billions from Medicare

Grant Richter, St. Louis, MO — Thu, 06 Dec 2007 01:07:20 GMT

People that are actually doing the stealing need the same punishment as the Aligator.
Some how we need to offer more Public Corporal punishment.

People that actually steal millions of dollars should probably face death. Upon proof of their crime, the punishment is carried out.

May sound cruel, but come on, if you are stealing millions of dollars, YOU KNOW exactly what you are doing.

I believe it would make people think twice, even three times.

Fake companies steal billions from Medicare

Furious and Frustrated in Florida — Thu, 06 Dec 2007 01:08:08 GMT

This has been a long-standing issue in our country. And let's face it, in this day and age of 'do more with less', it's extremely difficult to stay ahead of those whose primary goal is to cheat and defraud all of us who work hard and make an honest living. It is a National Crisis!!

I work for a third party administrator for senior market insurance. We specialize in Medicare Supplement and Long Term Care Insurance and have been fighting this battle for many years. We have taken numerous step toward detecting and reporting fraud and abuse, but it is extremely difficult. We identified several fraudulent medical supply providers in South Florida over the last year and I am very pleased to say that we helped to shut down between 30 and 40 of these fraudulent providers, but it takes time and resources. We exist in a country that functions on an 'innocent until proven guilty' system, which while imperfect, IS the greatest in the world. It takes a great deal of effort to obtain all of the necessary proof to obtain a conviction. The laws have been changed and some areas of fraud detection and prosecution improved, but much more needs to be done.

Unfortunately, the criminals are moving faster than the changes in the laws and there are not sufficient resources allocated at the federal level. Until our lawmakers truly understand how this affects our parents, our grandparents and even some of us now and the future of our children and change the process, prosecution and sentencing, no real change will be implemented.

Fake companies steal billions from Medicare

stop crying — Thu, 06 Dec 2007 01:13:55 GMT

this is a white collar crime my md. does it my dentist does it so does your if your lucky enough to have insurance check you eob's once in while. If Tyrone the air conditioner repair man is going to get real jail time for this so should my kids pediatrician, who billed cigna for 5 immunization shots when my kid recieved 3 last month. I'm not snitching this is how the republicans have made this country Everone is doing what they can to afford the $5.00 MILK and $4.00 a gallon gas.

Fake companies steal billions from Medicare

barbara, arlington, va — Thu, 06 Dec 2007 01:18:40 GMT

Perhaps we should turn this over to the IRS who seems to have the system down with finding and squashing people. Or your local police force who at least in Virginia will sniff out your car if it displays an expired county sticker and POW you have a $75 fine instantly and every time they pull you over. The better you are and the more you play by the rules the more you loose - our get rich society where those with the money are the winners will only get worse and those that will pay are the downtrodden struggling to survive. Remember this the next time you are told you OWE the IRS money at the end of a year in which you have surrendered 33% of your pay - bet these scam scums don't even have to pay the money they stole back. Shame on America

Fake companies steal billions from Medicare

Anne Brown, Jacksonville, FL — Thu, 06 Dec 2007 01:26:41 GMT

The Bush admin is more concerned about DENYING actual health care than preventing fraud and theft. After all, Bush & Cheney Co. have enthusiastically applauded, supported, enabled the looting of the American taxpayer's treasury from day one: Jan 20, 2001.

They're completely and unapologetically all for profit whether thru war crimes or medicare crimes. Profit is profit as far as they are concerned. It's human beings needing things like health care, retirement benefits and decent paying jobs that makes them pissed off and out for blood.

Fake companies steal billions from Medicare

kim baker, lancaster ,sc — Thu, 06 Dec 2007 01:36:50 GMT

goverment laws funny to think it all out for own ass and living as long as the goverment and laws take money in why worry with it its all bull shit the poor is still at all nds of it even if the truth is told

Fake companies steal billions from Medicare

Jim Thorpe — Thu, 06 Dec 2007 01:37:55 GMT

And people trust the government for socialized medicine?!? They screw up the current system as it is, can you imagine if they ran the whole thing?!?

Fake companies steal billions from Medicare

Deneace, Beaumont CA — Thu, 06 Dec 2007 01:46:42 GMT

What do you do when you have worked in a office that has committed Medicare fraud without your knowledge and didn't give you a full paycheck. Why isn't the government going after those people?

Fake companies steal billions from Medicare

jeri — Thu, 06 Dec 2007 02:00:42 GMT

As a physicians wife, nurse, office manager, and citizen it is all a shame what is occuring-- the upcoming generation has no chance and if you see your obituaries you will see its not the older people who are passing on its the busy working mothers, stressed middle aged men, who are taking on the burden for so many of the past generations who simply demand more than they ever put into any system.

Fake companies steal billions from Medicare

Scott Duff, MD Springfield Missouri — Thu, 06 Dec 2007 02:10:36 GMT

I am a physician in our great country. This story is interesting but lacks objective data to interpret the conclusions made - The reason there is no objective data is because the government has no way to follow the flow of revenue and expenditures accurately or with precision. This is due to the regulations and paperwork of Medicare being so massive that no one is an expert on these - honest, hardworking physicians and hospitals who are assisted by honest lawyer teams cant even stay compliant.
There is enough money in America to make a great medical system for everyone - we need to get the money directed to research, nurses, hospital support staff and doctors and out of the hands of insurance companies, pharmaceutical companies, surgical supply companies and "health care agencies". We need to simplify the rules. Please get active locally and nationally to make these changes-
Dr D, Springfield Missouri

Fake companies steal billions from Medicare

Jim Matthews, Edwardsville, IL — Thu, 06 Dec 2007 02:26:23 GMT

Let some private agency have a commission on all the fraud they find. (A bounty hunter, so to speak)
Legal, but fast, action would have to happen. But,this solution may not work, as high paid lawyers would get around the court system. HOW DID THIS COUNTRY GET SO MESSED UP!

Fake companies steal billions from Medicare

don riley Winfield, Kansa — Thu, 06 Dec 2007 02:30:36 GMT

If you read this thread you know this fraud has been going on for thirty-forty years. And you're blaming Bush for all of it? Get Real, liberals!!! That is truly stupid..
About 200 investigators need to be hired to dig out this frauders and put them far away in the prisons; or the lake! They money they save over and above their salaries and welfare should be MILLIONS for Medicare. They turn that down? WHY??

Fake companies steal billions from Medicare

Kenny, Birningham, Alabama — Thu, 06 Dec 2007 02:45:03 GMT

If you think this is bad, just wait until we end up with national health insurance. The abuses will be enormous.

Fake companies steal billions from Medicare

Average Joe, Middletown, CT — Thu, 06 Dec 2007 02:55:45 GMT

"Delving into this morass, you see some disturbing things: low-life criminals living in mansions, wearing fancy jewelry and driving luxury cars .."

Sounds like alot of members of Congress, doesn't it? Don't expect any changes in Medicare until Congress stops funding their own EXCLUSIVE medical plan, and jumps into the Morass with the rest of us.

Fake companies steal billions from Medicare

Ed, Angleton,Tx — Thu, 06 Dec 2007 02:59:52 GMT

My message is four fold.
First, did all of you notice that this fraud has been going on for 20-30 years. (People that includes the democrats)
Second, do any of you really believe that the government policing itself will work.
They lie about the Federal budget, so what makes you think anything will change.
Third, maybe the reason they have allowed all those extra people into this country is so we will have more opportunity for fraud within our Federal system.
The last note is to remind all of you who have forgotten about the THIRD GREAT LIE,
Hi, I'm from the government and I'm here to help you.
Wake up!

Fake companies steal billions from Medicare

Doc, Chicago, IL — Thu, 06 Dec 2007 02:59:55 GMT

you know who they are - you know where they are - you know what they did. Lock them up - RICO their $$$ and while your at it Get the 12 Billion back from Leon T. Black and lock his ass up.

Fake companies steal billions from Medicare

Caoimhe, FC, CO — Thu, 06 Dec 2007 03:22:25 GMT

This is ridiculous? This should not of happened at all. If they just file things properly they should be able to figure this out...Bush and all the Feds should be on this, and they all need to fix this, maybe it would be fixed if we do hire the immigrants for sleuthing this out...
C

Fake companies steal billions from Medicare

David Gill, Milano, Tx — Thu, 06 Dec 2007 03:23:47 GMT

And they Killed the Aligator

Fake companies steal billions from Medicare

Meloncholy, State of Disrepair — Thu, 06 Dec 2007 04:04:37 GMT

Why do we always have the same problems? Medicare fraud, immigration, global warming,...These are all the same issues that politicians swore they would solve, if elected. I am 54 and I remember the Vietnam Reports, the Rachel Clark books, the movie about the border killings and immigration, and every time there is an election coming up each side says they are going to fix all these problems. Federal politicians and local politicians are all the same...and our government by the people, for the people is exactly that...They enter politics to get the lowdown on real estate transactions etc..and graduate from there..and that's how the U.S. is becoming more and more a third world nation. Noone wants to do anything but run a game even on their parents. It is looked at as the only cool way to survive and it is bringing our nation to its knees because the ones really good at conning are making the rest of us their slaves....

Fake companies steal billions from Medicare

Don, Moore, Oklahoma — Thu, 06 Dec 2007 04:17:28 GMT

Medicare is not the only government health entity that is being defrauded. Before my most recent retirement I did software support for medical practices in San Diego, where Medicaid is called Medi-Cal.

One of my clients was billing Medi-Cal for physician services rendered by a PA (Physicians Assistant) but at Medical Doctor rates. We wrote him a letter explaining what he was doing was very illegal, turned him in to the authorities, and quit his account.

There are probably thousands of single-doctor practices who are stuggling to make ends meet who do similar things. Perhaps they are only over-billing (even false-billing) at $50 per encounter, but with so many practices doing this kind of thing it adds up very quickly.

Medi-Cal/Medicaid is losing millions of dollars with no enforcement in place.

Fake companies steal billions from Medicare

Craig C — Thu, 06 Dec 2007 04:26:30 GMT

Of course all this goes on while the politicians spend millions of dollars campaigning for re-election and virtually ignore their responsibilities!

On the other hand, even if they weren't spending months and millions campaigning, they still wouldn't have any interest in dealing with problems like this. The risk of them looking to "mean" to poor people is just too great to make it worth doing anything significant. It's no wonder their approval rating is 11%. They haven't done anything for years other than try to open the doors for illegal immigrants!

Fake companies steal billions from Medicare

RBH HOUSTON TX — Thu, 06 Dec 2007 04:43:14 GMT

MY FATHER PASSED AWAY IN 2002. THE "HOSPITAL" BILL SHOWED THAT HE WAS ON DIALYSIS FOR ABOUT SIX WEEKS WHEN HE WAS NOT EVEN IN THAT FACILITY. I CALLED MEDICARE, LIKE A GOOD CITIZEN TO REPORT FRAUD. MEDICARE LAUGHED AT ME BECAUSE THE CHARGES WERE ABOUT $7000. I GUESS IT WAS NOT ENOUGH TO PERSUE. IF THE CRIMINALS CHARGED EVERY PATIENT $7000 MORE, OUR SYSTEM WOULD BE MUCH WORSE. SO NOW WHAT DO WE DO? APPARENTLY, EVEN THOUGH MEDICARE COMPLAINS, THEY DO NOT WISH TO TRY TO GO AFTER FRAUD.

Fake companies steal billions from Medicare

PHILLIP HEALD, GARDNERVILLE, NEVADA 89410 — Thu, 06 Dec 2007 04:50:07 GMT

Got a news flash for you all,,,,,just try and find a phone number to report a case of medicare fraud,,,after only two months of searching,,i gave up and went with just local criminal charges of which the person was found guilty in a Riverside, Cal superior court and was ordered to pay me $35 a month until the whole amount of $15,000.00 she stole from me is paid back,,,I might live long enough to get all the money,,but at that rate I will never recoup my loss,,let alone the cost to medicare,,,all I hear is talk and no action,,,,action speaks louder than words,,,,,,,,,,,

Fake companies steal billions from Medicare

MJS, Smyrna, Ga — Thu, 06 Dec 2007 05:11:14 GMT

A major problem are these medical transport vans, which seem to be pushed in lower income areas. Somehow, not only do they take patients to the doctors, but to the grocery store. My big question is why is Medicare and Medicaid paying for these in the first place the rest of us have to get our own ride to the doctor.

Fake companies steal billions from Medicare

Paul House, Dallas, Texas — Thu, 06 Dec 2007 06:02:53 GMT

It is no secret that no matter how severe a person's condition is, or how much documentation a person has for their disability, NO ONE ever gets accepted for Medicare benefits on their first attempt. Medicare hopes the person will consider it not worth the trouble and simply go away.

Fake companies steal billions from Medicare

Doug DeHaut, Freehold, NJ — Thu, 06 Dec 2007 06:08:35 GMT

This is big goverment at work Vote Ron Paul

Fake companies steal billions from Medicare

Janeen RN Chicago — Thu, 06 Dec 2007 06:50:38 GMT

To Michelle Miranda: Don't give up trying to get some medical assistance. First, talk to hospital social workers for ideas. You may qualify for medicaid or another assistance program. Contact the companies who manufacture the drugs you take to see if you can receive them for free.Contact your Senator and State Rep. They have case workers who can help too. Do an internet search for "healthcare for the uninsured". There are a few national assistance programs out there. Lastly, ask your doctor to accept a reduced rate and to only order tests on you that will change your treatment or prognosis. Also, ask for samples at every doctor's appointment. Bring your med list with you and beg. I bake cookies for the doctors which seems to increase generosity. Good luck and don't give up!

For Linda Evans: Call 1800 medicare to report a fraud. Back it up in writing. Call amd write your State's attorney, Senator and State Rep as well. You may want to speak to an attorney who can advise you, but will want a portion or your whistle blower reward so be careful there. But you may only get results with a lawyer representing you. Good luck!

Fake companies steal billions from Medicare

Mary Beth Moran, Phoenix, Arizona — Thu, 06 Dec 2007 08:45:46 GMT

Thank you HIPAA!! Originated as a means to streamline the transactions in healthcare, HIPAA came into being, and then they tacked on the privacy and security portions -- what a joke. Since HIPAA's implementation, everyone sees healthcare as a huge river of money, and they all have a straw. Is it any wonder that organized crime would find its way into the river, also? For years, those of us who worked in healthcare were chastised for being so behind the times -- look at banking as an example. Well, banking has its problems with identity theft. But the real thieves realized there was much more money attached to your health care card than most peoples' credit cards ($1M+ as opposed to $20K), so they have shifted their attention. It will bankrupt the system and possibly finish off the nation.

Fake companies steal billions from Medicare

Don Kailua HI — Thu, 06 Dec 2007 08:51:09 GMT

This Is exactly why we do not want our government running a nationalized healthplan. Have'nt we figured it out by now? The more money taken from the taxpayers allows this to happen. If medicare does not have the means to pay, this would not happen. It is foolish to blame the thieves. They are thieves, that is what they do and have no desire to do anything else. By nature a thief is drawn to the easiest prey. Muggers do attack young healthy men, they prey on the weak. Bank employees embezzle from a bank. Why? Because they have lots of money their. This is not rocket science. If Medicare was not a bloated pile of money (your and my money) this would not be an issue. If you vote for someone who raises taxes, they will, and more of the same continues. Less government equals less fraud, it is that simple. Nothing will be done, because that means we will need a solution to the problem. There are too many people who have been getting theirs for years to have the plan changed. If Hillary gets elected, she will try to force through a change, (just more taxes please) to give us a worse system. Don't be fooled, It is just like the current Medicare drug plan. Ask your state senator how much that is costing each month. Go ahead, you will be shocked. That is the same as this issue, it just has not made the news yet.

Fake companies steal billions from Medicare

Bill Tobia, Glen Cove, NY — Thu, 06 Dec 2007 11:44:03 GMT

A major reason for this problem is CMS. One has to wonder why all of these people were able to get Medicare Supplier numbers in the first place. The doors have been wide open for years and CMS is only now requiring strict guidelines to get and maintain a Medicare billing number. In the meantime honest business owners, such as myself, are subject to numerous audits, erroneous payment rejections and delays while unscrupulous people just bill for equipment and services never given. Did you know that every other insurer that we bill for expensive equipment (such as motorized wheelchairs) requires us to submit extensive documentation for prior authorization before we can bill and get paid? Not so with Medicare. If you have a valid Medicare number and diagnosis code, you can bill and get paid several thousand dollars for these items. Medicare then follows up with post audits and asks for documentation on a percentage of those claims. If the documentation requested is not provided Medicare will re-coup the money paid. In the meantime certain individuals have billed millions of dollars for equipment never delivered and if they get caught for a few claims they are still ahead.

Our industry has been pressing CMS for higher standards (which they are about to implement) in order to prevent this type of abuse. We have also asked about a prior approval process for expensive items but we have been told it would be too "costly" to implement! I guess it's less expensive to pay billions in fraudulent claims than to hire medical review personnel to pre-audit claims.

The end result is that CMS has made it extremely difficult for a client to get a motorized wheelchair as the documentation requirements are extremely cumbesrome and time consuming for a physician to document as Medicare will only pay for equipment used in the home. If you do not need a wheelchair to get around in your home but need a wheelchair to travel longer distances outside your home, Medicare will not pay for it. Isn't it wonderful that Congress passed all those ADA laws several years ago but they will not pay for wheelchairs used only for outside the home? We have made the elderly prisoners of their own homes.

Hopefully, CMS will rescind billing numbers for fraudulent providers, do a better job pre-screening Medicare provider applications and initiate a prior approval system for expensive equipment and perhaps start to pay for wheelchairs for those who are confined to their homes.

Fake companies steal billions from Medicare

g.howes grand rapids mi. — Thu, 06 Dec 2007 12:05:59 GMT

if all the people who respond to this article whold write their congress person just maybe it might help, at least it would be worth the effort.

Fake companies steal billions from Medicare

James Travis, Buffalo New York — Thu, 06 Dec 2007 13:02:11 GMT

As a legitimate Medicare provider of Medical Equipment I am outraged over the Fraud and Abuse. Medicare is the only Insurance Company I know that pays a claim THEN investigates its legitimacy. There is a simple solution and it's one word, Preauthorization. You don't hear about Fraud in the Florida Medicaid system, or for Blue Cross, why?.The actually have a specialist determine Medical Necessity BEFORE the claim is paid, Dah!. Medicare actually has this system in place for some items, it could easily be expanded

Fake companies steal billions from Medicare

Justin Miller, Dublin,OH — Thu, 06 Dec 2007 13:02:23 GMT

It seems that everyone is on the same page. Private compaies may tick people off with their diagnosis sometimes but the do it to keep fraud from happening. Anyone who votes for universal healthcare run by the government should be tossed in with the gators as well, becasue it will be a duplicate fraud story to this one.

Fake companies steal billions from Medicare

Sam, Coldwater,MI — Thu, 06 Dec 2007 13:08:01 GMT

Why isn't there someone to monitor the system at all times. This is a rediculis raping of our medicare system. I am a physician and see how picky medicare is to us, but apparently lets crooks have it all.

Fake companies steal billions from Medicare

Big Paulie, Long Island, NY — Thu, 06 Dec 2007 13:12:16 GMT

It's all one big conspiracy and EVERYONE is in on it. The Feds control it all: imports, exports, drugs, tobacco, firearms, etc. The Feds have the sweetest retirement package set up for themselves; a hundred times better than the "Con" artists in Congress who by-the-way do not have to pay into Social Security. Forget about becoming a doctor or lawyer when you grow up; if you can become a Federal Agent you'll be set for life.

Fake companies steal billions from Medicare

Sam Coldwater,MI — Thu, 06 Dec 2007 13:25:31 GMT

Yes, I think you could buy the state of Michigan for 1 billion dollars right now. If this is happening to medicare WHAT ELSE is getting ripped off? Instead of increasing taxes all the time they need to decrease taxes and keep an EYE ON where the money goes. Enough said.

Fake companies steal billions from Medicare

Larry Nobles Gowanda, NY — Thu, 06 Dec 2007 13:38:26 GMT

Then there are the "legitimate" providers that bill for physical, occupational and speech therapy that was never given, meals that consist of one lettuce leaf and one tomato, provide "special behavior and Alzheimer's care" by providing a locked ward (no better than prison), (but they receive higher reimbursement) and the list goes on. This is one of many long term "care" providers. Try to turn them in to Medicare, the government makes it virtualy impossible, and especially if they donated to the party in power. Of course you get fired for being concientious and find out that you are not covered under whistle blowers laws. Luckily I was able to retire and receive SS and ??Medicare?? As long as patronage (lobbying) is allowed this will continue.

Fake companies steal billions from Medicare

Kevin Moser, Berkley Mi. — Thu, 06 Dec 2007 13:47:16 GMT

If they are raking in BILLIONS???? Why are they breaking into cars?

Fake companies steal billions from Medicare

Bob Bluni, Tallahassee, FL — Thu, 06 Dec 2007 14:02:51 GMT

The problem is that the Medicare system is a "pay now, ask questions later" system. Fraudulent provders often open for six months, bill Medicare then close and reopen under a new name. It takes Medicare that long to catch on that something isn't right with a company's billing. The system needs to change.

Fake companies steal billions from Medicare

danno85 — Thu, 06 Dec 2007 14:08:14 GMT

Has anyone contacted the law emforcement agencies?

Maybe someone should e-mail the atricle to the FBI or the Justice department! OH WAIT, I FORGOT, G W IS IN CHARGE! oh never mind he won't do anything like his job, that's too hard and complicated. George will probaly tell us that Iran sent agents over here to Florida to steal out medicare, yea that's the ticket, IRAD DID IT, I remember now!

Fake companies steal billions from Medicare

Doesn't surprise me......Nashville, TN — Thu, 06 Dec 2007 14:14:58 GMT

Hospital Corporation of America (HCA)did it for years, for untold hundreds of millions, and was only fined for the offense. No one went to jail for that as did other white collar criminals. It did help I suspect that the Frist's had Senator Bill Frist in Washington at the time.It's no small wonder that others think they can do it also.

Fake companies steal billions from Medicare

Thomas, Kansas City, MO — Thu, 06 Dec 2007 14:21:06 GMT

It's a shame that government focuses on increasing funding to government programs then cleaning up the loopholes which are used to defraud the government and taxpayers of billions.

Increase the funding and you increase the fraud. Increasing the funding for anti-fraud units and you will see more benefit.

I'm against raising taxes until government cleans up it's act and safeguards against fraud.

Fake companies steal billions from Medicare

outsource this, Seattle WA — Thu, 06 Dec 2007 14:23:26 GMT

I would believe our 'government' would do somthing about htis, if it werent for the fact that our government is also run that way.

Fake companies steal billions from Medicare

Victoria, Hopatcong, New Jersey — Thu, 06 Dec 2007 14:39:43 GMT

Corrupt??? Having to do with Medicare???? Oh My Goodness!!!! I'd hate to see what would happen if we got government funded health care for everyone! The government health care system would be broke in a day! Private enterprise needs to get back into health care for EVERYONE so we can keep the government out of our lives and at the same time, we will all save money

Fake companies steal billions from Medicare

pwhelton — Thu, 06 Dec 2007 14:44:01 GMT

The reason fraud is such a problem is that Medicare is administered by government employees. For the naive that claim Medicare fraud is a Bush administration problem your clueless! People have been scamming the government since day 1 in 1789 and
getting away with it for the same reasons as today. The great majority of government employees are not motivated and the crooks know it. Fleecing the government is like taking candy from a baby. Medicare should hire private companies to research and review all companies filing claims for services rendered. Incentavize these companies to route out fraud and the problem will be reduced substantially although never eliminated. As long as we depend on government employees to protect our money we will continue to see the results we have today. Oh yeah! For those that dream of a " free national health care system" would you trust your health and lives to a bunch of government "appartchiks"?

Fake companies steal billions from Medicare

Jay Kane Va. Beach, Va — Thu, 06 Dec 2007 14:47:17 GMT

What do you expect, You can't even call Medicare or any other big company and get an English speaking person. they are all speaking broken english that can barely be understood, so they are probably spanish and are in on the scams. This government is giving our country away..and that is the fact but its gonna get way worse before it gets better. Wake Up and Stand Up AMERICA before your country becomes Spanish....

Fake companies steal billions from Medicare

Chuck, McCormick, SC — Thu, 06 Dec 2007 14:52:31 GMT

Hey,wait a minute! As bad as this scamming of Medicare is, what about the "legal" ripping off of Medicare by hospitals and care facilities?
Actual Example from a hospital bill (and I'm sure, many more just like it):
Mucous Recovery System: $1000.00
Medicare promptly pays the adjusted percentage.

Definition of mucous recovery system:
1 Box of Kleenex tissues

No wonder that there are thousands of criminals who easily and continuously collect from Medicare. So, what do we do? Throw hospital administrators to the alligators as well?
What a ridiculous system!!

What we need is the equivalent of junk yard dog protection against Medicare fraud, where the bark is loud and the bite is fatal.

Fake companies steal billions from Medicare

Y. Smith Denver, CO — Thu, 06 Dec 2007 15:00:44 GMT

I called the Medicare Fraud line, turned in a doctor who was double billing under two TIN's, and it took asking for a Supervisor three levels up to get anyone to even listen, and I had proof. Medicare could care less, and the first three levels of employees told me they just pay them and don't bother. Teach Medicare to listen to their customer's.

Fake companies steal billions from Medicare

Sheila Bradwell — Thu, 06 Dec 2007 15:03:11 GMT

When physician-run collusions for fraud are involved, and IF they are caught, in addition to any conviction, they probably lose their medical license. Unfortunately, in many states, they can get them back after a # of years (in NYS it is 3 years). This should not happen!

Fake companies steal billions from Medicare

James Welkl, Ft Bragg, NC — Thu, 06 Dec 2007 15:07:07 GMT

Let's not play the "babe in woods" role of the innocent. This is not something that happened overnight. This is as old as the land, just a new version of what politicians, presidents, secretary of defense, vp's have been "palying". Let us not act "shocked". Medicare is a system that "people", dishonest thieves, crooks rob as often as they can. It is the dishonest doctor, who bilk the insurance companies for unnecessary procedures or procedures NOT performed. It is the nurse who in order to please her "boss", the doctor, adds suuplies never used to the the bill. There was a time when you visited your doctor, he looked at you and said, what can I do for YOU. Today when you visit the doctor they look at you size you up, so to say, and plan all the procedures that can be billed. Your well being is no longer the central issue, your purse, your insurance, medicare card is the MAIN ISSUE, how much they can bill. They, the doctors have an unwritten agreement among themselves, to pass the "innocent patient" from one specualits to the other, as long as the insurance lasts. The MEDICAL profession became as a "leach on society".

Fake companies steal billions from Medicare

Jaron — Thu, 06 Dec 2007 15:09:19 GMT

And we want socialized medicine in this country? Hmm...of course no one will overbill for treatments and drugs that are never used in a government ran medical plan. Um, yes, I will take some of those orange groves in Alaska, thank you for offering.

Fake companies steal billions from Medicare

Miriam Martinez, Miami, Fla. — Thu, 06 Dec 2007 15:10:10 GMT

Why don't we start by reviewing the medicare/medicaid officers, the one who approve the provider No. (the key for billing.) Are they doing their due diligence or are they also been part of the fraud?

Fake companies steal billions from Medicare

Grady Nelson — Thu, 06 Dec 2007 15:11:59 GMT

They are the same people that claim they are not allowed to vote and when they do vote, they can not figure out how to punch a chad or use the machine

Fake companies steal billions from Medicare

Heidi Weldon, Yuma, AZ — Thu, 06 Dec 2007 15:20:09 GMT

I worked many years ago in a medicare office. I frequently brought up incidents that I knew were fraud. Males being billed for female proceedures, foot care for a person that had that foot removed years earlier, power wheel chairs for people that walked just fine into the office to pay bills, the list goes on and on. I was told it was not my job to say anything about this. My job was to enter codes and file the paper work. This was in 1974 so I can only imagine the billions in fraud that has occured since then.

Fake companies steal billions from Medicare

Ken Driessen — Thu, 06 Dec 2007 15:21:48 GMT

Profit is the bottom line no care for fellow humans or country. If people want fair pay for fair work make the levi(tm)genes in China. If you want your buddies to profit from war go on the longest vaction of any president and read the pet goat on 9/11. Work the revolving doors of defense contractors and the pentagon. Rape medicare like George W. Bush wants to anyway! Can anybody else see the swastica on our flag? The worst liars and theives advance in our growingly sick nation. When I was young I was a nurse aid and later a first responder and I saw blood and guts. I helped people and wanted to be a doctor. Maybe I should have joined the others like Bush and Dick and be a thief? NOT

Fake companies steal billions from Medicare

Danny Trantham, Wichita Ks — Thu, 06 Dec 2007 15:24:32 GMT

My girlfriend worked at a medicare call center last year and shocked me when she said at a meeting they were told to only talk 3 minutes max and to cut off the client(GRANDMA)if they exceeded this time.

This is sick, we all at one point will rely on this system that controls our healths stability.

There are so many people involved in benifiting from this scam it is nearly impossible to stop such abuse. The FBI legally cannot investigate because it is a federal offense. Ha great way to cover your tracks, with whistle blowers being the main way exposure the lid is closed.

If we werent paying blackwater billions of dollars in contracts to inapropriately discrace the American people than maybe we could support ways to put an end to this issue nationally.
Talk is cheap, Bush is connected to several instances of fraud & hushed scandols, i mean come on these are parties that have enough money to buy their way into complete control.
Why was gold missing from under the twin towers after destruction, why did the owner of the buildings mysteriously change his insurance plan to cover even a plane collision just weeks befor the tragic events of 911. Why did it look like a controlled demolition planned and percisely carried out by our government. These issues obviously stem deeper than the average American wants to comprehend, most have been brainwashed into whats new with Britney Spears. Thats rite where they want us daised and confused, easier to control. HELLO am i getting through to anyone, im a college student, i should be worrying about my homework or my girlfriend but instead i have to wonder if China is going to take over us or why theyre building concentration camps in the US, why they are installing shackels in train cars. on and on i could go, this will continue until we have no freedom to literally think.

"This body reminds me of my own mortality, embrace this moment, remember were all eternal and all this pain is an illusion"(Alex Grey)

God Bless, Daniel Trantham

Fake companies steal billions from Medicare

Steve T. Phoenix Arizona — Thu, 06 Dec 2007 15:25:41 GMT

The saddest thing about this article is the comments generated. We have become a nation of malcontents and whiners. The media grabs onto to the story of the day to show us how bad things are, how inept our government is and how hopeless the situation is. The comments to the article prove that we believe whatever they tell us.
Have you asked why you haven't seen more stories about the successes of our healhcare system and the genuine dedication and caring that so many dedicated people provide?
How many people of the world would love to have our problems.

Fake companies steal billions from Medicare

mike reynolds — Thu, 06 Dec 2007 15:35:55 GMT

the american public is to blame for all of it. you keep sending the same reps to congree yr after yr. nobody to blame but yourselfs

Fake companies steal billions from Medicare

Scott Booker, Auburn, IN. — Thu, 06 Dec 2007 15:36:09 GMT

As a legitamate Home health care worker that seems to be lumped in with the "bad guys" I just wanted to point out a couple of things:

1)All claims have to be accompanied by a written Rx and signed by a doctor. Why aren't we hearing about these corrupt docs?
2)Medicare essentially gives us an anal exam for every patient we file for, yet swallows these claims easily... why?
3) An explaination of benefits is mailed to each patient for each claim paid. Patients should be overwelmingly calling when they see the fraud, but they aren't. Some of them are actually "in" in the scam.

Fake companies steal billions from Medicare

willard eversole — Thu, 06 Dec 2007 15:36:17 GMT

can you imagine all the fraud that will take place if miss hillry could get universal health care.if we cant control fraud now,god help us.we need mandatory laws that would put these crooks in prison for the rest of their life, without any possibility of parole,and any crooked lawyer that tried to do other wise put them there too.

Fake companies steal billions from Medicare

willard eversole — Thu, 06 Dec 2007 15:36:19 GMT

Fake companies steal billions from Medicare

Tom Oesterling, South Bend In — Thu, 06 Dec 2007 15:50:51 GMT

As American Citzens we need to wake up. This is just one example that we are on our way to losing our freedom as a Nation if we as individuals do not act responsively. One may ask why should I act responsively? Is it not an element of ingrained morality in each of us. The sad truth is morality is on the decline in our Nation. This is just one example of it. To start we need less government and less interference of entities like the "civil liberties union" denying education in our schools on the understanding the basis of our moral roots.

Fake companies steal billions from Medicare

frustrated,stuart,fl — Thu, 06 Dec 2007 15:52:49 GMT

The solution to this should be easy, but maybe not. Obviously, a doctor should have to be in good standing with his state medical board to qualify for reimbusement. This could be resolved by information sharing between the states and Medicare. Here in Florida, however, we have a bigger problem. Many businesses are regulated by the Board of Professional Regulation which generally requires that you have a license and be in good standing. There is a big loophole. If you can find someone with an active license you can legally pay them to use their license even though you may be legally barred from having the license because of a criminal history or inability to pass the licensing exam yourself. I know of one contractor in this exact situation. He is in business here in Florida. He even uses his address as the license address though it's not his license. He's been doing this for twelve years and it's legal. The State of Florida has no idea where the original contractor lives and is not interested. I discovered when doing research for a lawsuit.

Fake companies steal billions from Medicare

Gerald W. Ragland — Thu, 06 Dec 2007 15:53:35 GMT

Which is more applicable in these situations,peoples apathy or complacency? In our United States, even the neighbor next door,is relentless in acquiring anything they feel is or might be valuable to self. That is the way our world rotates.

Fake companies steal billions from Medicare

Gail Clarke, St. Pete,FL — Thu, 06 Dec 2007 15:55:46 GMT

Perhaps we are largely to blame for this mess. Medicare sends me - as I am sure they do to everyone on Medicare - a benefit statement showing the doctor/medical facility, amount charged and amount paid. I carefully read these to be sure there are no discrepencies. If EVERYONE did this and if a charge was made that was not legitimate, it could be reported immediately and these abusers would be caught a lot soon. It's time we the people take responsibility in this issue.

Fake companies steal billions from Medicare

Bob Smith, Childress,Tx — Thu, 06 Dec 2007 16:13:19 GMT

I knew one pharmacist in LA that purchased a $5 million dollar ocean going tug boat and 6 $1 million dollar push barges, bought 4 huge plantations, owned a boutique, had two custom Rolls-Royces made and shipped from England, and other fancies. This was all accomplished out of a little pharmacy the size of a one car garage. When medicare caught up with him, they gave him a choice. He had to pay a $5K dollar fine or have his license revoked. Big Deal!

Fake companies steal billions from Medicare

JC WAGEN — Thu, 06 Dec 2007 16:19:10 GMT

MEDICARE EMPLOYEES DO NOT CARE! My sister who is on disability called and reported over,double and non existence care billing. They told her to report it to the doctors and hospital billing depts.
The patient always gets a bill copy-summary from medicare as to what medicare was billed---no payment should be made until the patient signs off on the summary and sends it back to medicare aknowledging correct charges for services or goods. This could be done via phone or internet also. It would be a step in correcting errors as well as the bilkers and would save millions and very little to admin.

Fake companies steal billions from Medicare

Boris Romanoff — Thu, 06 Dec 2007 16:26:35 GMT

I believe that honest people like ourselves should have the right to get the best medical care available.How on earth is it ever going to be possible with such abuses taking place?

Fake companies steal billions from Medicare

D. Barkley, Napoleon, OH — Thu, 06 Dec 2007 16:35:40 GMT

As a retired federal worker with 25 years service, I can indeed attest to seeing government waste. However,
in that time, it was equally wasted by both Democrat's
and Republican's. So I wouldn't blame Bush. The comment about investigating Medicare Fraud and being hampered by HIPPA rules. Try and find out any medical information about someone you may be a Caregiver for, even if it's to try and determine if they're a victim or being used to defraud. Could be they aren't able or
capable of signing documents giving you access, and see how high and thick the HIPPA Rules wall will be.
And it was President Clinton, who signed that bit of foolishness into law. (Am willing to bet, there are some folks in Omaha today, who were stonewalled by HIPPA, when calling to try and find out about loved
ones, and were cussing that law.) But I digress. What
I believe that might help, would be for a ruling that would require "every kind" of medical billing to be done in clear and concise ways. Positively every band
aid, 4X4 gauze, instrument pak (explain it's use or why it was needed), pill or procedure explained. This way, hopefully, duplicate or questionable items, can be seen and questioned. Too much is hidden.

Fake companies steal billions from Medicare

Jenn, Roswell, GA — Thu, 06 Dec 2007 16:36:27 GMT

Chris in Savannah, I think it's great that you can afford $200/month to buy health insurance for your family. But I am 22, work full-time, as does my fiance, and we have trouble keeping the car running. Not to mention I'm going to be having a baby in about a month, and I don't know if I'll be able to pay rent when I'm out of work! So, we do need MediCare and MedicAid because there are people out there that seriously need it (it's the only way I've been able to go to the doctor and pay for the birth). We need a better way of monitoring the billing, but a universal health care system would make life much easier for the majority of Americans. Just because you happen to be better off than most of the middle class these days (which is a fact, the middle class is poorer now than it was 10, 20 and 30 years ago) does not mean you should take away the only saving grace that we have left!
But about the main point, the American gov't needs to have harsher penalties (including repayment of the stolen funds) for MediCare fraud. And they need more investigators (or just alligators!) to rectify the problem. We also need doctors to stop over-billing for every little thing; but that goes back to the office/hospital's high overhead because of MediCare/MedicAid "investigations" that don't fix anything. It's a nasty circle, and we are all paying for it.

Fake companies steal billions from Medicare

Sam Moss — Thu, 06 Dec 2007 16:38:34 GMT

Yea, blame everything on Bush. This just goes to show your ignorance and understanding of this type business. As a legitimate company who provides services to these patients’s who need it, you must understand the system. Medicare has ramped up their inspections of these type companies. They have started a system to make all providers in South Florida and Los Angeles (which most fraud is committed) to re-apply for their Medicare supplier number. This program will require an onsite inspection to make sure these companies are legitimate. Also, as a company who provides these services to patients who really need home care equipment, it is extremely difficult to deal with Medicare. The Government run Medicare program is out of touch with reality when it comes to helping patients in need, and Medicare’s lack of understanding of this business. You want Government run healthcare for everyone in the country, and then this is what you would get. Homecare can save billions of dollars to the tax payer if only Medicare understood the healthcare business. You have doctors and all healthcare providers trying to get out of dealing with Medicare because of their ineptitude. Onerous burdens are put on all providers that are legitimate and only want paid for their legal services. It is a sad day when many Americans want universal healthcare but lack the understanding that our Government has no clue on how to run this business. If our Government would only take the time to understand the way healthcare works, it could save billions. I could go on, but you must be in this industry to understand how sad it is to deal with Government and their lack of understanding.
Lastly - Medicare has been around long before Bush, so get off of blaming Bush for everything. It's incredible that anything that does not go to some peoples liking, it's Bush's fault. If you don't believe me, just watch MSNBC's Keith Olbermann show. It's all he talks about. He opens his show every night bashing Bush, even though there are stories such as the shooting in Nebraska yesterday. If that's wasn't a top story, then what was? Bush, according to Keith Olbermann

Fake companies steal billions from Medicare

Julian C. McCulloch — Thu, 06 Dec 2007 16:38:52 GMT

I have a good one. I own a physical therapy office and have been hounded by a contract company to repay $100,000 that Medicare "overpaid" from 2003. I did nothing wrong but get paid for the services I provided. I tried talking to Medicare but got a different answer each time I talked to someone. Finally, the Justice Dept. and the U.S. Treasury Dept. contacted me demanding payment. I have paid back $75,000 and will pay the final payment this month. Tried contacting my Senators and Representatives to no avail. By the way, I am a law abiding tax paying citizen.

Fake companies steal billions from Medicare

Jenn, Roswell, GA — Thu, 06 Dec 2007 16:55:36 GMT

And I can't even get someone on the phone at MedicAid to change my address and update my information! How are they going to check on every claim made by every person with every doctor or hospital?

Fake companies steal billions from Medicare

PoorGuy, Waynesville, NC — Thu, 06 Dec 2007 16:59:44 GMT

Socialized medicine is great if the alternative is no medicine which is the case for a lot of us.

Fake companies steal billions from Medicare

Steven Marshal, Ventura, CA — Thu, 06 Dec 2007 17:11:00 GMT

I think it is fantastic to see that people are getting rich off of the system. The healthcare system in this country is ridiculous anyway, somebody other than the pharmaceutical companies may as well get some revenue from it! The fact that Pfizer was fined 634 million dollars for distribution of Oxycontin (synthetic heroin which is addictive within 5 DAYS OF USE!) for not putting a strong enough warning on the box, and signed the check without even batting an eyelash should tell you something. The hospitals, the pharmaceutical companies and 99 percent of all doctors are "FOR PROFIT" only and could care less about the welfare of the patient. Doesn't the hypocratic oath state "Above all do no harm"??? I have no sympathy for those who are being taken advantage of, it is your own fault for allowing this system to manifest and grow into an almost unopposable entity...you made your bed, now lie in it. The day that people realize that to be healthy why not tap into dietary and exercise avenues, take care of your body and you will be healthier and stronger...much longer! Deepak Chopra stated that if you allow your body to perform all five essential functions fully (Eating, Breathing, Digestion, Metabolism and Elimination all under control of a master system called the nervous system) you would eliminate 95 percent of all disease which leaves only 5 percent to genetics (which is the stress of environment on our ancestors anyway). C'mon, really, do you think that cancer is running rampant all of the sudden because we just discovered it? Or maybe it's because of all the poor diets, lack of exercise and poor air quality along with all the poisons being prescribed by so called "health care professionals". Cancer is a multibillion dollar industry...FOR PROFIT! And by the way, I have Non Hodgkin's Lymphoma...so yes, I know.

Fake companies steal billions from Medicare

Elaine Chandler Hixton, Wi — Thu, 06 Dec 2007 17:14:18 GMT

This country is almost done in. We, the people, need to stand up and take control.Are there any honest people left here? We could have our great country back if we all protested the fraud.Help us find a way to do it NOW! For Gods sake don't elect Hillary.

Fake companies steal billions from Medicare

St. Germain St. Helens Oregon — Thu, 06 Dec 2007 17:19:57 GMT

Sad, however; concidering our Gov. hasn't outlawed smoking even though it kills thousands a year, and genorates mass medical expeditures....hmmm...oh yea that's right they collect huge tax revenues off the industery. I'm quite sure the Gov. gets a cut of the money that goes into the medicare program not what comes out of it (other then taxing the providers on their profits). So hey why would the Gov. care after all they already got their cut. Also, why hasn't the IRS sent out the pitbulls?. The Gov. should at least make sure the criminals are paying their taxes like the rest of us.

Fake companies steal billions from Medicare

Polly Munnerley, Pensacola, FL — Thu, 06 Dec 2007 17:32:28 GMT

If the Congress would stop the constant bickering long enough, we might get some legislation thats worth something other that party wars.

Fake companies steal billions from Medicare

Penny, Phoenix, AZ — Thu, 06 Dec 2007 17:32:51 GMT

Why is everyone so shocked? My husband's father was seeing the same doctor every week for years and was charged $200 a month. When Medicare first came in the fees the doctor billed Medicare were over $1000 per month and the treatment stayed the same. That's pretty good pay for 15 minutes work.

Fake companies steal billions from Medicare

Sarah Core, Atlanta, Ga — Thu, 06 Dec 2007 17:32:51 GMT

Chris in Savannah, please tell us who your insurance company is that only charges $200 for family coverage?
Or did you mean that is what you pay, and your employer picks up the rest. Having worked in accounting and HR, I have not seen any plan that could provide full family coverage for only $200 per month.

Fake companies steal billions from Medicare

Ralph, Clinton, NJ — Thu, 06 Dec 2007 17:34:42 GMT

It always amazes me how "ordinary" people can make some suggestions that will solve the problem, in this case the (ongoing for many years) Medicare scam. Yet our government officials, which we literally entrust our lives to, are incapable or unwilling to do anything about it. Our government wants to,, at all cost, to bring upon the world our system of so called democracy....well, we better clean our house first before we go tell the world how to run theirs.

Fake companies steal billions from Medicare

MDean, Dallas, TX — Thu, 06 Dec 2007 17:40:09 GMT

The government auditors do not seem to care. I called them to report that we had received notice of payment for three flu shots in 5 weeks for a relative who is now deceased (she did die due to flu shots). Any one was for three times the charge that most doctors and clinics was charging. They seemed disinterested and even annoyed at the Medicare office. I seemed to be interrupting their siesta. As far as I could find out, they never did any investigation or took any action on the complaint.

Fake companies steal billions from Medicare

D.C.Man — Thu, 06 Dec 2007 17:47:41 GMT

To Tyler from Salem Oregon. Whta else from an Oregon resident should anyone expect. Your anwser will solve the problem. Remember, the Democracts put Medicare in place. It's sad when folks just can't say anything worth while when it's all Bush's fault. This is the stupidity we must put up with and it's sad to think folks like Tyler has the right to vote. Stop this gene pool.

Fake companies steal billions from Medicare

FreddyK, Mpls MN — Thu, 06 Dec 2007 17:51:19 GMT

Drastic situations require drastic measures.
I kinda like the "swim with the alligators" solution myself.

Fake companies steal billions from Medicare

pamador — Thu, 06 Dec 2007 17:57:19 GMT

so now what? Why don't we get undercover agents to pose as patients and arrest all these crooks! Throw them to the alligators, they deserve it!

Fake companies steal billions from Medicare

Arden Doe Indianapolis, IN — Thu, 06 Dec 2007 17:59:13 GMT

They'd do something about it if we all told them to collect our taxes from the $ being stolen and if we didn't write any more checks to the IRS until they did stop them. I'm about fed up with this "American" way of life these days. Pathetically "American" seems to have become synonymous with self-serving, cheating, greedy, profit mongers who do it all with a suit and tie on -all the while telling US what is and isn't moral! DISGUSTING

Fake companies steal billions from Medicare

Bob — Thu, 06 Dec 2007 18:05:12 GMT

These are the people who deserve to be held in Maxium security....For the rest of their miserable lifes.
Fraud which targets the poor and dying requires extream punishment. IE...public flogging before very long prison terms!!! Make people think before they act!

Fake companies steal billions from Medicare

HelpUsNotDestroyUs, United States of America — Thu, 06 Dec 2007 18:06:14 GMT

The reason the people on The Hill can't solve the problems, they're behind the problems. They know all the loopholes and find someone to make their porfits roll in. No way one can make an honest living and do all the things, (these people) are doing. I'm not saying all the people on The Hill are behind this type of behavior, but; quite a few. What's the purpose of offshore accounts if all that they do is legal.

Fake companies steal billions from Medicare

FreddyK, Mpls MN — Thu, 06 Dec 2007 18:12:14 GMT

The Medicare bureaucracy is completely out of control so it's no surprise that it is highly vulnerable to these scammers. I doubt if it can now be policed adequately.
About the only thing on the good guy's side is the fact that these idiots aren't satisfied with their big payoffs from ripping off Medicare, it's in their genes to continue the petty stuff like car break-ins... and that's where they will eventually be caught. Nature weeding out the stupid.
(moral: Never jump into an alligator swamp with your hands tied behind your back)

Fake companies steal billions from Medicare

Peter Snow, Newberg Oregon — Thu, 06 Dec 2007 18:20:22 GMT

I guess the REAL fraud is when Bush manipulated the voting and ended up in office and is spending our tax money on a fraudulent war and not dealing with the in-country problems like fraud in the medicare system. Since the system is BROKE why don't we tell Bush and those spending millions to get into office that before they go any farther to come up with real plans to FIX the system before they get into office.

Fake companies steal billions from Medicare

Thomas Senath, Mo — Thu, 06 Dec 2007 18:20:45 GMT

i work for a medicare billing dme in southeast ,mo and i know first hand how particular they can be when it comes to paying for medicare approved products. so someone please tell me how some low life scammers{who are stealing from there parents and children} are getting away with it. you need docotors approvals notes and dignosis before you can even bill and at times we still get denied. if there is a medicare task force someone tell them to wake up they are getting ripped off.

Fake companies steal billions from Medicare

Autumn, Spring Hill Florida — Thu, 06 Dec 2007 18:27:21 GMT

I just think that all of this is absolute nonsense. I'm so fortunate that I work in the healthcare industry and that I'm aware of the billing fraud that occurs. I have been able to educate family members and friends of the do's and don'ts with healthcare and managing their own explanation of benefits and medical records. The billing fraud isn't the only thing increasing our insurance premiums, it's also increasing due to our own lack of education to take care of our health. It's a constant battle. You have physician's that will go the extra mile to explain your chronic health condition and how to improve it. Then, you have physician's who would rather not share that information with you, to only keep having you attend appointments and receive more medications. More medications benefit the physicians, pharmacies, and fradulent billers who have their hands out. It's sad.

Fake companies steal billions from Medicare

ActivistNYC New York, N.Y> — Thu, 06 Dec 2007 18:27:26 GMT

In NYS under Pataki (our nice Republican governor) there was NO oversight of medicare fraud as a matter of policy. It could not even be reported. Things have changed with Spitzer. E- your representatives-- all of them-- with the link to this article!

Fake companies steal billions from Medicare

(Rick Wilson, Oxnard,cal.) — Thu, 06 Dec 2007 18:35:43 GMT

I have been in the home medical equipment buisness for over 35 years. As of today, I could not tell you how these people are getting away with this crime. Everything we provide to Medicare patients is looked at under the microscope. But I can tell you that our industry has been yelling for years to have MEDICARE(cms) stop giving billing numbers, to every Tom,Dick and Harry. I became Accredited back in 1988 with the understanding that Medicare(cms) was going to make it mandatory. Today 20 year"s later our industry is still asking for that mandate. Mandatory Accredition would help remove fly by night's and they would not be able to bill Medicare. WHAT A CONCEPT. Our industry has several websites that are helpfull. VGM.COM and AAhomecare.org.
Help our industry push for mandatory Accredition by calling your local/state congressional offices. Also ask that billing numbers should NOT be given without it.
Thanks in advance for your support.
Rick Wilson

Fake companies steal billions from Medicare

Dr. Rick — Thu, 06 Dec 2007 18:51:08 GMT

People just don't get it, the fraud is in the private, for profit, sector. Doctors overbilling and over-prescribing, medical equipment suppliers manufacturing disabilities for people so they can run around with scooters and adjustable beds, pharmaceutical companies charging 2 or 3 times what Canada Charges. The government has no control under this private for profit system. With a single payor system, like stealing your mail, it will be a major offense against the government to cheat the system and they will hopefully be able to set limits on costs of drugs by making volume purchases. It is the only way to change this corrupt, medical industry to ever have a chance for every american to be treated evenly.

Fake companies steal billions from Medicare

Sheila Kansas — Thu, 06 Dec 2007 18:51:35 GMT

The problem begins with the government regulators- they require companies to apply for a Medicare billing number before they can start billing Medicare as well the company must renew this number every 3 years.

The medical company is suspossed to be inspected for legitimacy as well as complaince with Center Medicare & Medicaid Service (CMS-goverment agency oversight) supplier standards before obtaining their Medicare billing number.

THE PROCESS IS IN PLACE FOR THESE INSPECTIONS TO HAPPEN- BUT IT IS NOT HAPPENING COONSISTLY- as the company,Palmetto GBA National Supplier Clearing House in Surfside Beach, SC, that CMS contracts with to perform this service has an outdated computer system and not enough funds And staff to perform all THE REQUIRED inspections.

I work for a medical company and I sit on a committee that tries to address our fraud concerns with the NSC and CMS. The NSC staff say their hands are tied by CMS and they are doing the best they can. CMS never shows up for the conference calls or facs-to- face meetings to address the legitimate supplier concerns.

Seems like the savings from fraud would more than pay for the necessary inspection staff and updated computer system.

THE REAL PROBLEM WITH ALL OF MEDICARE AND MEDICARE SPENDING IS THE BUREAUCY OF THE CENTER FOR MEDICARE & MEDICARD SERVICES. THEY SPEND ALOT OF TIME CREATING PAPER AND RULES THEY ARE NOT WILLING TO ABIDE BY. THEY HIDE UNDER THE NOT ENOUGH FUNDING EXCUSE BUT SCREAM FRAUD WHEN THEY DONT DO THEIR JOB

Mr Potter- you might want to check out the GAO report on the NSC that was published in 2005-- it was right on target.

Fake companies steal billions from Medicare

Sandra Kansas City — Thu, 06 Dec 2007 19:01:23 GMT

I work for a medical company that DOES NOT comit fraud- the government is always after us to prove services... I do not understand how the fraudulent companies go undetected???

Furthermore, I have personally reported companies to Mecicare that commit fraud and nothing ever happens to them. The self-onitoring theroy does not work because the government does not listen.

I have been in meetings where members of CMS and the Mecicare contractor have admitted to knowing that certain companies are committing fraud in their television adverting.----yet years later these same television ads are still running in violation of Medicare guideleines. An example of this is a Medicare guidelines state a company cannot give free product to a Medicare beneficiary to entice them to use their company. There are still ads that run for diabetic supplies that promise a free meter if you purchase your diabetic supplies from that company.....

Fake companies steal billions from Medicare

Lorraine Taube Brockway Township, Michigan — Thu, 06 Dec 2007 19:03:17 GMT

I don't understand that people don't understand that it is not the fault of the programs congress puts in place but the underpaid workers that are suppposed to carry them out. My sister in the food stamp system and could tell you some stories. These people just don't care. They put in their 8 hours talking on the phone or whatever and go home. She said it's a wonder anything gets done.

Fake companies steal billions from Medicare

Lori Sells, New Johnsonville TN — Thu, 06 Dec 2007 22:41:17 GMT

But here also is another classic example of the American people assuming that they will always be taken care of by – their government, medical providers, health insurance companies both private and state/federal, etc. So many individuals believe that everything will run smoothly without any intervention by themselves (or their personal representatives); that they are not responsible for their own protection and survival.

With that said – I have tried for the last 3 plus years to offer my services as a medical billing patient advocate. I have marketed my business and services to the young and old, individual and corporate alike but to no avail. For one, because my service is so new and unique it takes me, sometimes, hours to explain so just an ad in the paper doesn’t get it. Secondly, the ones I have spoken too believe that they don’t need me because they have Medicare or their insurance company watches out for them or they have someone at the doctor’s office that helps them.

I have worked in healthcare for 21 years – specifically in the medical insurance billing and collection. I have even been a Medicare Fraud investigator. I understand this process probably more that most in the US – that is not to say anyone is stupid, it’s just the US healthcare billing system is confusing at best. I consider myself a professional in this area of expertise. I only want to help others – to keep them from paying more than they should. My services have helped not only my clients, but the medical providers and the insurance companies as well. (Mistakes seem to have a trickle effect.) I know nothing about the electrical wiring in my house therefore I do not hesitate to call an electrician if I need help. There is no reason to not turn to a professional for advice or assistance when there are medical billings involved. Everyone must watch out for their own self!! The entities involved in healthcare are too large and convoluted to watch each individual claim.

Yes, I know there are many comments made regarding the reporting (or attempt to report) of fraudulent billing activities. Kudos for you for trying!! But your probably not going to get far by just calling your local Medicare carrier. These lines are understaffed, underpaid, undertrained and overworked. You can call the HHS Medicare Fraud Hotline, but do make sure it’s truly fraudulent or abusive billing – some are instances of honest mistakes or the Medicare recipient not understanding the billing process so the charges are legitimate. Always check with your medical provider first. If the Hotline is bombarded with useless information then it will cease to be useful!

Fake companies steal billions from Medicare

Becky fr Wyoming — Fri, 07 Dec 2007 12:34:57 GMT

This is exactly why we don't need goverment running social programs in our country. This is exactly what will happen if we have a social healthcare system from Hillary Clinton. Healthcare is not the problem (I know I pay for my own healthcare for me, my wife and son for less than $200 a month), the problem is the power hungry people in Washington

Well aren't you lucky. I have a 22 year old daughter who works for a company that keeps telling her the wrong dates to apply for her health insurance. I lao have a son who also works full time that does not have healtth insurance because it is not offered where he works and gettinginsurance on his own is way more than he can afford. There are many people like my kids in this country.
Wake up, the only way to get a hold on the cost of health care is to get the problem taken care of before the cost is sky high. I will vote only for someone who has a Health Care Plan for my kids.
Then President Bush won't even help children to be covered. Thousnads of Americans need health care but they delay thatt care until it is so bad that the cost is very high. Guess who is paying for that? You and me are because those who can't pay, the cost is sent to the so called big Social Services in the sky.