Monday, September 6, 2010

Medicare Fraud and Abuse – from CBS 60 Minutes Program

Preface: In case you missed it, what follows is a shortened version of a September 5, 2010 story on Medicare Fraud and Abuse from the CBS 60 minute program. It is a repeat of its program first seen on October 25, 2009. This is important because Obamacare is specifically designed to save Medicare from bankruptcy. Yet $60 billion of Medicare’s $423 billion in costs are from fraud and abuse. This raises the question: Will the government be able to handle the $950 billion expansion of health care slated to take place over the next ten years?

Of all the problems facing the United States right now, none are more important than health care.

President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.

At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits.

In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

This story may raise your blood pressure, along with some troubling questions about our government's ability to manage a medical bureaucracy.

If you want to find Medicare fraud, the first place you should look is South Florida, where 60 Minutes and correspondent Steve Kroft were told it has pushed aside cocaine as the major criminal enterprise.

It's a quiet crime - there are no sirens or gunfire. The only victims are the American taxpayers, and they don't even know they are being ripped off.

FBI Special Agent Brian Waterman, who 60 Minutes rode with for several days, told us the only visible evidence of the crimes are the thousands of tiny clinics and pharmacies that dot the low-rent strip malls.

You don't even know they're there because there's never anyone inside. No doctors, no nurses and no patients.

"This office number should be manned and answered 24 hours a day," Waterman explained, standing outside one of those small, unstaffed businesses.

The tiny medical supply company billed Medicare almost $2 million in July and a half million dollars while 60 Minutes was there in August, but we never found anybody inside, and our phone calls were never returned.

Sometimes, they don't even have offices: we went looking for a pharmacy at 7511 NW. 73rd Street that billed Medicare $300,000 in charges. It turned out to be in the middle of a public warehouse storage area.

"They've already told us that there's no offices here," Waterman told Kroft. "There are no businesses here. In fact they are not even allowed to have a business here."

Waterman is the senior agent in the Miami office in charge of Medicare fraud. And Kirk Ogrosky, a top Justice Department prosecutor, oversees half a dozen Medicare fraud strike forces that have been set up across the country.

The office Kroft visited operates out of a warehouse at a secret location in South Florida and includes investigators from the FBI, Health and Human Services, and the IRS.

"There's a healthcare fraud industry where people do nothing but recruit patients, get patient lists, find doctors, look on the Internet, find different scams. There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare," Waterman explained.

"Is the Medicare fraud business bigger than the drug business in Miami now?" Kroft asked.

"I think it's way bigger," Ogrosky said.

Asked what changed, Ogrosky told Kroft, "The criminals changed."

"Sophistication," Waterman added.

"They've figured out that rather than stealing $100,000 or $200,000, they can steal $100 million. We have seen cases in the last six, eight months that involve a couple of guys that if they weren't stealing from Medicare might be stealing your car," Ogrosky explained.

"You know, we were the king of the drugs in the '80s. We're king of healthcare fraud in the '90s and the 2000's," Waterman added, speaking about South Florida.

7 comments:

HaynesBE said...

How much Medicare fraud is truly criminal, and how much is inadvertent miscoding, which can be coding for reimbursement too low as well as coding too high? Does anyone know?

Richard L. Reece, MD said...

I am not sure anybody knows. John McDaniels, President of Peak Performance Physicians, a practice management firm, estimates, based on annual audits, that undercoding is much more common than overcoding by a factor of about 4:1.

HaynesBE said...

I wish it was more widely known that physician are cited for fraud and fined for undercoding. Odd sort of "fraud" to be fined for--charging less than your service was worth.

Richard L. Reece, MD said...

There may be some confusion here. I do not think physicians are cited for fraud for undercoding but for overcoding or misrepresentation of what they do. John McDaniels of Peak Performance Physicians tells me doctors undercode 80% of the time. The other 20% is not necessarily overcoding or fraud and abuse but coding without adequate documentation

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Anonymous said...

The problem is there is a ton of fraud and most people are in denial because the people who are committing the fraud are those we hold in high positions because they are educated and supposed to be doing good for the community. The truth is there are a lot of people in healthcare who do a lot of good for their communities but you have those who use this persona to perpetuate their greed and other vices at the expense of the taxpayer.

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