Why Health Care Is So Expensive: Health Insurance Fraud?
Raymond
YOU all pay one way or another and YOU can stop medical fraud.
Fraudulent behavior may loosely be defined in the health insurance
context as any behavior designed to solicit money to which a person or
group is not entitled. There are so many kinds of health insurance
fraud it would be difficult to list them all. This is especially the
case because fraud involving health insurance is perpetuated by a
variety of sources, including health insurance companies, insurance
brokers, unscrupulous doctors, chiropractors, allied health
professionals, medical institutions, and patients
Some examples of institutional or health professional led health
insurance fraud include the falsification of information on forms.
This is not always meant for the personal benefit of the health
professional or the institution. Sometimes a doctor will omit
information on forms that would lead a patient to not get treatment
because of a pre-existing condition, or a hospital will change the
time of admission slightly so a patient isn’t charged for a whole day.
Though these actions are well meaning, they are nevertheless
fraudulent because they do not make an accurate report to the
patient’s insurer.
Intentional health insurance fraud does not even have this excuse of
trying to help a patient. Instead, doctors, allied health care workers
or hospitals may file false claims, claim treatments for patients that
never occurred, fill prescriptions under patients’ names and then sell
them on the black market, diagnose diseases that do not exist, and
order unnecessary testing. Occasionally, a medical worker works in
collusion with a personal injury attorney to falsify medical reports,
in which case more than one type of insurance fraud may be
perpetuated.
Health insurance companies or brokers may also commit various forms of
health insurance fraud. The biggest of these is not paying on
legitimate claims. Some companies may intentionally deny payment in
the hopes that claimants will not protest the treatment. They could
also deny based on reasons that are unfounded or illegal, but can
reverse their decisions if people bother to investigate the denial.
Routine misrepresentations of coverage may fall under the health
insurance fraud umbrella too. When insurance representatives do not
truthfully disclose information on what is covered, which can happen,
they may be defrauding their customers by avoidance of payment, or by
discouraging customers to get treatments they need, which truly are
covered by their insurance.
Alternately, some “health insurance companies” or “brokers” are not
truly legitimate and are instead scammers looking to make a quick buck
on people who are desperate for health insurance. They have no
intention of paying claims and merely want to collect their money. An
additional type of health insurance fraud is making false claims about
what is being sold. For instance, health discount plans are not
insurance. When they are represented as insurance, this may be a
fraudulent act. Selling insurance in a state in which a company is not
licensed to operate is fraud too.
Lastly, patients can commit health insurance fraud in a variety of
contexts. They could make false claims about illnesses for any number
of reasons. If an insurance company demands any form of physical, and
a patient doesn’t provide accurate information, this could be viewed
as fraudulent and might void any coverage. Also, patients who are
willing participants in the fraudulent acts of physicians or
facilities that misreport information are a party to fraud and could
be prosecuted.
http://www.wisegeek.com/what-is-health-insurance-fraud.htm
Two Doctors Arrested In Prescription Drug Fraud Probe - Topix
http://www.topix.com/forum/news/drugs/TBH1F29RFL11VNAGD
Arrested Sixteen In $2 Million Medi-Cal Pregnancy Fraud. California
Attorney General Brown announced the arrest of two physicians,
http://www.jerrybrown.org/record/healthcare
Two Tallahassee Doctors Arrested for Prescription Fraud
http://www.wctv.tv/home/headlines/68644777.html
2 North Hollywood Doctors Arrested for Medi-Cal Fraud Scheme.
http://www.federalcriminaldefenselosangeles.com/Blog/Categories/Medi-Cal-Fraud.aspx
The California Department of Insurance and the Orange County District
Attorney's Office have arrested three doctors for medical fraud. ...
http://www.insurancejournal.com/news/west/2007/05/17/79811.htm
Brooklyn Arrests Are Part of "Largest Medicare Fraud Bust Ever .
.http://www.nbcnewyork.com/news/local-beat/Feds-Break-Up-80M-Medicare-
Medicaid-Scam-in-Brooklyn--98611629.html.
Dozens Arrested In Medicare Fraud Busts Across US
http://www.huffingtonpost.com/2009/07/29/federal-agents-raid-houst_n_246883.html
20 Arrested In California Medicaid Fraud Case - Kaiser Health ...
http://www.kaiserhealthnews.org/Daily-Reports/2009/July/10/California.aspx
Several doctors and nurses were among those arrested in Miami,
New .... health care or medical fraud against a federal (i.e.,
Medicare, ...Doctors among those arrested in $251M Medicare scams 720
indictments collectively have billed the Medicare program for more
than $1.6 billion.
We're putting would-be criminals on notice: health care fraud is no
longer a safe bet
Thank you President Obama
Updated 7/16/2010 4:22 PM |
MIAMI — Federal authorities said Friday they are conducting the
largest Medicare fraud bust ever in five different states and arrested
dozens of suspects accused in scams totaling $251 million.
Several doctors and nurses were among those arrested in Miami, New
York City, Detroit, Houston and Baton Rouge, La., accused of billing
Medicare for unnecessary equipment, physical therapy and HIV
treatments that patients typically never received. Ninety-four
suspects were indicted, and authorities said 36 people had been
arrested as of Friday morning.
More than 360 agents participated in Friday's raids, announced by
Attorney General Eric Holder and Health and Human Services Secretary
Kathleen Sebelius at a health care fraud prevention summit in Miami.
Officials said they chose Miami because it is ground zero for Medicare
fraud. Authorities indicted 33 suspects in the Miami area, accused of
charging Medicare for about $140 million in various scams.
"With today's arrests we're putting would-be criminals on notice:
health care fraud is no longer a safe bet," Holder said Friday.
Cleaning up an estimated $60 billion to $90 billion a year in Medicare
fraud will be key to paying for President Barack Obama's proposed
health care overhaul. Federal officials have promised more money and
manpower to fight fraud, setting up strike forces in several cities
http://www.usatoday.com/money/industries/health/2010-07-16-medicare-scams_N.htm
Hospital Larceny. Warning ! Hospitals overcharge patients by $10
billion a year, or an average of $1,300 per hospital stay Never pay
the bill before leaving the hospital. You may be told this
is required, but it is not
March 1, 2010
Health care – Prescription for waste: $1000 toothbrush
Posted: 09:00 AM ET
American Morning - amFIX blog
Filed under: Health care - Prescription for waste?
We should all ask for itemized bills from the hospitals . You will be
suprised at what will be on that statement that you did not get but
were charged for.
http://groups.google.com/group/alt.health/browse_thread/thread/b3b594613cba0411#
Is Your Dentist Committing Insurance Fraud? You could be libel.
Options
http://www.associatedcontent.com/article/472440/is_your_dentist_committing_insurance.html?cat=5
Medicare Scams: 94 Charged In Schemes Totaling $251 MILLION
KELLI KENNEDY and TOM HAYS | 07/16/10 09:38 PM
16415
views907 Assistant Attorney General Lanny Breuer, left, speaks to the
media as Loretta Lynch, center, U.S. Attorney for the Eastern District
of New York, and other law enforcement officials announce charges
against doctors, health care company owners, executives and others in
a case of alleged false medicare billing at a news conference in the
U.S. Attorney's office in the Brooklyn borough of New York, Friday,
July 16, 2010. (AP) Get Politics Alerts
Email Comments 907 MIAMI — Elderly Russian immigrants lined up to take
kickbacks from the backroom of a Brooklyn clinic. Claims flooded in
from Miami for HIV treatments that never occurred. One professional
patient was named in nearly 4,000 false Medicare claims.
Authorities said busts carried out this week in Miami, New York City,
Detroit, Houston and Baton Rouge, La., were the largest Medicare fraud
takedown in history – part of a massive overhaul in the way federal
officials are preventing and prosecuting the crimes.
In all, 94 people – including several doctors and nurses – were
charged Friday in scams totaling $251 million. Federal authorities,
while touting the operation, cautioned the cases represent only a
fraction of the estimated $60 billion to $90 billion in Medicare fraud
absorbed by taxpayers each year.
For the first time federal officials have the power to overhaul the
system under Obama's Affordable Care Act, which gives them authority
to stop paying a provider they suspect is fraudulent. Critics have
complained the current process did nothing more than rubber-stamp
payments to fraudulent providers.
"That world is coming to an end," Health and Human Services Secretary
Kathleen Sebelius told The Associated Press after speaking at a health
care fraud prevention summit in Miami. "We've got new ways to go after
folks that we've never had before."
Officials said they chose Miami because it is ground zero for Medicare
fraud, generating roughly $3 billion a year. Authorities indicted 33
suspects in the Miami area, accused of charging Medicare for about
$140 million in various scams.
Suspects across the country were accused of billing Medicare for
unnecessary equipment, physical therapy and other treatments that
patients never received. In one $72 million scam at Bay Medical in
Brooklyn, clinic owners submitted bogus physical therapy claims for
elderly Russian immigrants.
Patients, including undercover agents, were paid $50 to $100 a visit
in exchange for using their Medicare numbers and got bonuses for
recruiting new patients. Wiretaps captured hundreds of kickback
payments doled out in a backroom by a man who did nothing but pay
patients all day, authorities said.
The so-called "kickback" room had a Soviet-era propaganda poster on
the wall, showing a woman with a finger to her lips and two warnings
in Russian: "Don't Gossip" and "Be on the lookout: In these days, the
walls talk."
With the surveillance, the walls "had ears and they had eyes," U.S.
Attorney Loretta Lynch said at a news conference in Brooklyn.
In a separate Brooklyn case, authorities charged six patients who
shopped their Medicare numbers to various clinics. More than 3,744
claims were submitted on behalf of one woman alone, 82-year-old
Valentina Mushinskaya, over the past six years.
At a brief appearance in federal court Friday, Mushinskaya was
released on $30,000 bond and ordered not to return to the Solstice
Wellness Center, scene of an alleged $2.8 million scam.
Authorities called Mushinskaya one of the clinic's "serial
beneficiaries," with phony bills totaling $141,161 paid by Medicare.
Her nephew, Vladimir Olshansky, told reporters his Ukrainian-born aunt
suffers from diabetes. "She doesn't know what this is about," he said.
"She's in the dark."
In Miami, Daniel R. Levinson, inspector general of HHS, which oversees
Medicare, said the arrests "illustrate how health care fraud schemes
can replicate virally and migrate rapidly across communities."
Cleaning up Medicare fraud will be key to paying for President Barack
Obama's proposed health care overhaul. Federal officials have
allocated more money and manpower to fight fraud, setting up strike
forces in seven cities with a plan to expand to a dozen more. So far,
the operations are responsible for more than 720 indictments that
collectively billed the Medicare program more than $1.6 billion.
Around the country, the schemes have morphed from the typical medical
equipment scam in which clinic owners billed Medicare dozens of times
for the same wheelchair. Now, officials say, Medicare fraud involves a
sophisticated network of doctors, clinic owners, patients and patient
recruiters.
Violent criminals and mobsters are also tapping into the scams, seeing
Medicare fraud as more lucrative than dealing drugs and having less
severe criminal penalties, officials said.
For decades, Medicare operated under a system that paid providers
first and investigated later. That pay and chase method was a boon for
crooks, giving them 90 days lag time to milk the system and flee with
millions before authorities were aware a crime had been committed.
Sebelius toured vacant storefronts in Miami on Friday where Medicare
fraudsters set up shop, including bogus clinics operated by Cuban
immigrants Carlos, Luis and Jose Benitez. The brothers are the
agency's most-wanted fugitives, charged with bilking $119 million for
costly HIV drugs that patients never received – and buying hotels,
helicopters, boats and even a water park with their spoils. They
allegedly fled to Cuba, where authorities believe they remain.
A new joint effort by HHS and the Department of Justice enables law
enforcement to view Medicare claims in real time and flag suspicious
patterns. More stringent screening methods, including more
comprehensive background checks, have also been put in place. The
agency gets roughly 18,000 applications daily to become a Medicare
provider. Now they can put a moratorium on new applications in certain
areas, like physical therapy, if they notice a spike in fraudulent
activities.
The changes are paying off.
Common practice – Report A Company That Double Billed The Government
For Health Care or Medical Goods & Services–
Investigators visited 1,600 providers in Miami in the past few months,
making sure legitimate businesses were operating at the addresses. In
2008, authorities required all medical equipment providers in Miami to
apply for new certification, hoping the paper hurdle would deter
scammers. The number of claims dropped by $1.6 billion._
Hays reported from New York.
Let us prey
--- American Medical Association - Physicians,...Hospitals... Misc
Health Care Providers
Raymond
>
> Arrested Sixteen In $2 Million Medi-Cal Pregnancy Fraud. California
>
> Two Tallahassee Doctors Arrested for Prescription Fraudhttp://www.wctv.tv/home/headlines/68644777.html
>
> 2 North Hollywood Doctors Arrested for Medi-Cal Fraud Scheme.http://www.federalcriminaldefenselosangeles.com/Blog/Categories/Medi-...
>
> The California Department of Insurance and the Orange County District
>
> Brooklyn Arrests Are Part of "Largest Medicare Fraud Bust Ever .
> .http://www.nbcnewyork.com/news/local-beat/Feds-Break-Up-80M-Medicare-
> Medicaid-Scam-in-Brooklyn--98611629.html.
>
>
> 20 Arrested In California Medicaid Fraud Case - Kaiser Health ...http://www.kaiserhealthnews.org/Daily-Reports/2009/July/10/California...
>
> Hospital Larceny. Warning ! Hospitals overcharge patients by $10
> billion a year, or an average of $1,300 per hospital stay Never pay
> the bill before leaving the hospital. You may be told this
> is required, but it is not
>
> March 1, 2010
> Health care – Prescription for waste: $1000 toothbrush
> Posted: 09:00 AM ET
> American Morning - amFIX blog
>
> Filed under: Health care - Prescription for waste?
> We should all ask for itemized bills from the hospitals . You will be
> suprised at what will be on that statement that you did not get but
> were charged for.
>
>
> Is Your Dentist Committing Insurance Fraud? You could be libel.
Medical Fraud Carries A Staggering Price Tag
About Medical Insurance Fraud : Consumers bear the cost of fraud,
which represents and ever- growing burden in the form of increased
premiums, taxes, co-pays, and deductibles." ... and Medical Insurance
Fraud May Even Jeopardize Patients' Health
Health insurance fraud represents one of America's largest taxpayer
rip-offs ever, costing Americans literally billions of dollars every
year. Americans don't seem to care as long as Medicare pays the bills.
However, fraud raises everyone's premiums.
By Cameron Easey, eHow Contributor
Insurance fraud exists for companies and individuals that provide
services as well as pay premiums. Insurance fraud has the effect of
raising the rates that individuals pay for policy premiums and can
even affect patients' health. This is because insurance companies are
paying for a benefit that was not authorized. Understanding the most
common types of insurance fraud can help to educate individuals to be
aware of fraudulent tactics.
.Medical Equipment Fraud
One type of scheme is called medical equipment fraud. This is the
process of offering a free or discounted product from a manufacturer
to an individual. The fraud occurs, then the insurance company is
billed for the product whether the product was needed or not. In some
cases a product may not have been offered or delivered at all.
Unnecessary Tests
Another type of fraud involves various types of tests that are billed
to an insurance company. These can include tests that occur at health
clubs or retirement centers. Test that seem legitimate but may not
necessarily be needed include x-rays or ultrasounds for certain types
of chiropractic care.
Services Not Performed
One of the most common types of medical insurance fraud is billing for
services that were never performed. These can include billing an
insurance company for an office visit even though only a phone call
was made to the office. In addition, bills can be altered or fake ones
submitted in the hopes of getting a reimbursement from the insurance
company.
Medicare Fraud
Medicare fraud includes many types of fraudulent schemes but the
difference is that the elderly are targeted for this type of fraud.
Individuals that engage in Medicare fraud offer a service or product
to a person who is on Medicare to obtain their identification numbers.
The fraud occurs when individuals forge a doctor's signature and then
bill Medicare for a medical device that is not needed or was never
delivered.
Kickbacks
A kickback is a type of medical fraud that involves receiving a
payment for a service or referral. This type of fraud increases
medical costs because an overpayment is usually involved. The person
receiving the kickback will forward the payment but pocket the amount
that was "overpaid." The person or organization making the kickback
will charge higher amounts to continue making the kickbacks.
HEAT Task Force Success
Health Care Fraud Prevention and Enforcement Action Team (HEAT)
Background:
Health care fraud perpetrators are stealing billions of dollars from
the federal government, American taxpayers and some of our most
vulnerable citizens. This not only drives up costs for everyone in the
health care system, it hurts the long term solvency of Medicare and
Medicaid, two programs upon which millions of Americans depend.
The Department of Justice (DOJ), the Heath and Human Services (HHS)
Office of the Inspector General, and the Centers for Medicare and
Medicaid Services have worked together, through the criminal and civil
systems, to secure thousands of criminal convictions and obtain civil
administrative actions against individuals and organizations
committing Medicare Fraud. In addition, in 2009 alone, more than a
billion dollars in health care fraud monies have been recovered under
the False Claims Act.
Administration support:
The President's 2010 budget for HHS contains funding for anti-fraud
efforts over five years that we estimate could save $2.7 billion by
improving overall oversight and stopping fraud and abuse within the
Medicare Advantage and Medicare prescription drug programs. It also
invests $311 million to strengthen program integrity in Medicare and
Medicaid, with particular emphasis on greater oversight of Medicare
Advantage and Medicare Prescription Drug programs.
Current Actions:
Strike Team Activity in Baton Rouge, Brooklyn, Detroit, Houston, Los
Angeles, Miami-Dade and Tampa Bay – ongoing
Outreach meetings with top Anti-Fraud leaders in Congress, Law
Enforcement and the Private Sector including Providers - ongoing