Health Care Fraud: US Medicare & NHS Reform

It is likely that health care will be delivered free to patients (still) in the UK, but it is also likely that with the involvement of the private sector all patient related work will be charged: to the GPs and not the government.

With no limit as to where a patient needs to register, the system is going to be open to abuse; serious abuse.

It is singularly peculiar that governments do not seem to learn form the mistakes of others.

Money corrupts and I like to believe that most doctors are honourable and yet it is because of that that many do not realise how wicked a few of us could be.

©2008 Am Ang Zhang

New York Times

 July 16, 2010

Dozens Arrested in Medicare Fraud Totaling $251 Million

MIAMI (AP) — Federal authorities said Friday that they had arrested dozens of suspects in five states on charges of defrauding Medicare of a total of $251 million.

Several doctors and nurses were among those arrested in Miami, New York, Detroit, Houston and Baton Rouge, La., accused of billing Medicare for unnecessary equipment, physical therapy and H.I.V. treatments that patients typically never received. Ninety-four suspects were indicted, and the authorities said 36 people had been arrested as of Friday morning.

More than 360 agents participated in Friday’s raids, which were announced by Attorney General Eric H. Holder Jr. and Kathleen Sebelius, the secretary of health and human services, at a meeting in Miami on preventing health care fraud. The authorities indicted 33 suspects in the Miami area, accusing them of defrauding Medicare of about $140 million.

Cleaning up an estimated $60 billion to $90 billion a year in Medicare fraud will be an important part of paying for President Obama’s overhaul of the health care system. …….. Now, officials say, the schemes involve 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 instance, agents bugged a medical center in Brooklyn, where eight people are charged with running a $72 million scam that submitted bogus claims for physical therapy for elderly Russian immigrants. Clinic owners paid patients, including undercover agents, in exchange for using their Medicare numbers and a bonus fee for recruiting new patients. Recording devices captured hundreds of kickback payments in a private room where a man sat at a table and did nothing but pay patients all day, the authorities said.

“With today’s arrests we’re putting would-be criminals on notice: health care fraud is no longer a safe bet,” Mr. Holder said Friday.

Good luck to Mr. Holder!!! We seem to have heard the same about drug hauls.

History of Medicare fraud:

2008:

Medicare did not detect that more than one-third of spending for wheelchairs, oxygen supplies and other medical equipment in its 2006 fiscal year was improper, according to the report. Based on data in other Medicare reports, that would be about $2.8 billion in improper spending.

2009:

Arrests in three separate cases in Brooklyn, Detroit and Miami included a Florida doctor accused of running a $40 million home health care scheme that falsely listed patients as blind diabetics so he could bill for twice-daily nurse visits.       Also>>>

But hospitals too:

CNN:

>>>How about My bill from ….. for a $540 tongue depressor. Or one for a $270 2oz. cup of liquid Motrin?

>>>While she was in the hospital a few days old, we were charged for 11 pacifiers at a cost of $121.00 each.

>>>My 70 year old father was hospitalized with Legionnaires Disease. His hospital bill included a bill for a pap smear! His first name was Faye – the hospital must have assumed he was a woman and could scam the insurance company for the charge.

UK Dental Fraud: 2007, 2008, 2010