Obama admin. crackdown on health care fraud leads to 85% more prosecutions

[Chadman]

Obama admin. crackdown on health care fraud leads to 85% more prosecutions

By Kase Wickman
Tuesday, August 30th, 2011 -- 12:15 pm
Rawstory.com

Under the newly reformed health care laws championed by President Barack Obama, it's not only what people pay for insurance that will change, but also the way people pay for insurance crime.

The number of prosecutions for health insurance fraud is already 85 percent higher in 2011 than it was in 2010, thanks to new and expanded health care fraud teams created by the reform, USA Today reported.

Last year, the government recovered a record $4 billion from health care fraud under the nascent laws. This year, the haul could be even larger with the increase in prosecutions.

The Transactional Records Access Clearinghouse, a non-partisan group at Syracuse University that submits Freedom of Information Requests and analyzes the findings, released data on the prosecutions from the Justice Department.

In the first eight months of 2011, the Justice Department has already prosecuted 903 cases, compared to the 731 prosecuted in all of 2010.

If the rate of prosecutions holds steady, TRAC predicted about 1,350 cases this year, just short of double last year's prosecutions.

The increase is due to a crackdown on private agencies, as well as a few large busts that boosted numbers. In February, for example, 111 people in nine cities were charged with Medicare fraud in a connected ring ? the largest-ever federal health fraud takedown, representing $225 million in fraudulent claims.

"The trend certainly looks accurate and on track with our data," Justice Department spokeswoman Alisa Finelli told USA Today, though she said she could not confirm the exact numbers.

Convictions from task force action are also up. Last year, 23 Medicare fraud convictions were made. This year, there have been 24 convictions and rising.

The Justice Department's criminal division Assistant Attorney General Lanny Breuer praised the work of the task forces.

"That's just a stunning number when you see it in the first eight months," he said. "We're just going to build on this model, and we're going to hold those responsible who are stealing from the government."

 

[ssd]

....unfortunately, the cost of prosecuting these individuals was $14billion......

(just kidding.)


Congrats to the DoJ on capturing the scammers

 

[azbob]

Here's an example of the "scammer" they are catching.

Without going into too much detail, every time you go to the hospital a code is added to whatever is done to you (say a surgery) based on the diagnosis, co-conditions, results, etc...think of it like trying to find a yes or no answer in the tax code...there is room for error if something is mis-coded.

The government is no auditing every hospital to see if every code was chosen correctly. If an error is found, it is not attributed to a mis-key or a mistake or misinterpretation...it is attributed to fraud and there is a huge monetary penalty.

This is one of the ways we are paying for Obamacare.

As a new patient today, the first thing a doctors office will ask is, "are you on Medicare?" If your answer is yes, they will not take you as a patient. Many docs in Cali are already cash only and the only state without a primary care physicain shortage is Texas because they enacted tort reform.

It's not really a great idea to ask hospitals and doctors to pay for Obamacare by criminalizing routine errors because that will have a more dramatic effect on healthcare than anything else.

 

[Chadman]

With all due respect, Bob, how do you know what "scammers" they are catching? How do you know that mistakes in these hospitals are being labeled fraud? Have you seen the records? Maybe so - can you provide examples or just your personal opinion based on a general dislike of "Obamacare."

I'd also like to see evidence of what you suggest that doctor's offices are patently refusing patients who are on Medicare. Any doctors here want to chime in - or others working in the profession? Any statistics to back that concept up? Again, maybe there is - would be interesting to see.

 

[Duff Miver]

Here's an example of the "scammer" they are catching.

Without going into too much detail, every time you go to the hospital a code is added to whatever is done to you (say a surgery) based on the diagnosis, co-conditions, results, etc...think of it like trying to find a yes or no answer in the tax code...there is room for error if something is mis-coded.

The government is no auditing every hospital to see if every code was chosen correctly. If an error is found, it is not attributed to a mis-key or a mistake or misinterpretation...it is attributed to fraud and there is a huge monetary penalty.

This is one of the ways we are paying for Obamacare.

As a new patient today, the first thing a doctors office will ask is, "are you on Medicare?" If your answer is yes, they will not take you as a patient. Many docs in Cali are already cash only and the only state without a primary care physicain shortage is Texas because they enacted tort reform.

It's not really a great idea to ask hospitals and doctors to pay for Obamacare by criminalizing routine errors because that will have a more dramatic effect on healthcare than anything else.

That's a total load of crap. No one is being prosecuted for clerical errors. I'm calling you a liar, azzzzzzbob.

And there are still many, many doctors accepting new Medicare patients. You're lying about that too.

Here's the truth, from an AZ newspaper -

MedPAC found that over 90% of doctors who accept Medicare are taking new patients. Another independent study found that 92.9% of doctors accept Medicare patients.

http://tucsoncitizen.com/medicare/2011/08/23/doctors-not-taking-medicare-patients-true-of-false/

You are a liar, azzzzbob.

You make up lies and post them all the time, azzzzbob. You're a serial liar. You need to back off the booze and get some help.

 

[azbob]

Here's what the link to your article says Duff:

2005 95.5% of docs accepted new MC patients
2008 92.9% accepted

Your posted article said, "MedPAC found that over 90% of doctors who accept Medicare are taking new patients."

Three things...that doesn't say they are taking new MC patients...90% continues the downward trend and, do you know anything about MedPAC? Doctors aren't going to tell them they have stopped taking MC patients because they will threaten their current payments.

That's a US loss of about 40,000 docs no longer accepting those patients and most of those are primary care docs.

I actually have a job and it is in healthcare. If any of you know someone in healthcare other than the ED staff who deny your drug seeking every weekend, ask them about RAC.

Chadman...YES...I have seen the records and been involved in monitoring the appeal process (more wasted money) plus I've been involved in bringing in consultants to counteract the RAC (more wasted money) and I've been involved in buying software specifically designed to audit the RAC results (more wasted money).

All of that money is not being devoted to patient care or hiring new people.

While you sit in your LazyBoy typing away with negativity on anything posted, there are people in the real world dealing with the issues you write off to racism, poor statistics or lack of understanding of the human condition.

The only reason to join these posts is to try to share you ideas or learn something. I have truly learned something about the state of the country and its educational system from the "quality" of posts here and the "ideas" expressed.

 

[The Sponge]

The only reason to join these posts is to try to share you ideas or learn something. I have truly learned something about the state of the country and its educational system from the "quality" of posts here and the "ideas" expressed.

Classic. :142smilie

 

[ssd]

C'mon, BOB. Your post contains way too many facts and not enough derogatory language. I have to neg rep you for this.

The fact that you have a job, in healthcare and wrote a post about it is issue for another neg rep but I can't give you anymore until I hit someone else with some.

:mj01:

 

[Duff Miver]

Your posted article said, "MedPAC found that over 90% of doctors who accept Medicare are taking new patients."

Three things...that doesn't say they are taking new MC patients...
I actually have a job and it is in healthcare.
.

It doesn't say what? Do you mean this 90% of doctors who accept Medicare are taking new patients."

And here, direct quote from the NYT article referenced by the Tucson paper:

?There was a small decline in Medicare acceptance, but it wasn?t very dramatic,? Dr. Bishop told me in an interview. ?Well over 90 percent of doctors, in all kinds of specialties, still take new Medicare patients.? July 6, 2011

Face it, azzzzzbob, you got caught lying again.

You got caught lying that clerical errors are criminally prosecuted when that has never happened.

You got caught lying saying doctors aren't taking new Medicare patients when most do.

You also got caught lying when you said Fed gas taxes are distributed to the poor.

Your a liar, Bob, caught red-handed and flat-footed.:mj07: :mj07: :mj07: :mj07:

 

[bleedingpurple]

Most examples of medicare fraud that I HAVE researched suggests that hospitals and nursing homes DELIBERATELY frauded medicare. Haven't read many with clerical errors. Now I will admit I only googled it and a list of schemes popped up. Not clerical errors.
Hospitals hire many many people to go over codes, over and over again. Utilization and review teams often attempt to make sure that the patient's are being properly diagnosed and receiving the proper treatment. Clerical errors SHOULD BE difficult to make but I am sure they do happen just not at the rate where I would consider most to be clerical errors. From what I have read and have been told is that most fraud is deliberate.

 

[THE KOD]

Most examples of medicare fraud that I HAVE researched suggests that hospitals and nursing homes DELIBERATELY frauded medicare. Haven't read many with clerical errors. Now I will admit I only googled it and a list of schemes popped up. Not clerical errors.
Hospitals hire many many people to go over codes, over and over again. Utilization and review teams often attempt to make sure that the patient's are being properly diagnosed and receiving the proper treatment. Clerical errors SHOULD BE difficult to make but I am sure they do happen just not at the rate where I would consider most to be clerical errors. From what I have read and have been told is that most fraud is deliberate.

........................................................................

you are fooling yourself with this thinking.

About 4 years ago I was in the hospital with no insurance. The total bill from the hospital was around 3,500 dollars

When I questioned the bill as being inflated I was told that the bill was the bill. So I made the phone calls and got them to send me the codes that I was charged for and what it was for.

It was like a fawking telephone bill. I must have made 20 phone calls to billing and supervisors and hospital customer service and anyone else that would listen.

The thing about it was that when I was sleeping they were showing I was taking medicine drips that I was not taking. There were many examples of confusing costs that made no sense.

Either they gave up or got scared I was going to report them to Consumer Affairs in the State Dept

But they backed off the bill down to 1800 dollars.

I paid it.

So who should go to jail for that kind of abuse to patients that are helpless to know what is going on with their care.

Fraud is rampant.

We need to jump this shit and stop it.

We will all be able to get good care if we do.

Hospital profiteering has to stop.

 

[Chadman]

Chadman...YES...I have seen the records and been involved in monitoring the appeal process (more wasted money) plus I've been involved in bringing in consultants to counteract the RAC (more wasted money) and I've been involved in buying software specifically designed to audit the RAC results (more wasted money).

All of that money is not being devoted to patient care or hiring new people.

While you sit in your LazyBoy typing away with negativity on anything posted, there are people in the real world dealing with the issues you write off to racism, poor statistics or lack of understanding of the human condition.

The only reason to join these posts is to try to share you ideas or learn something. I have truly learned something about the state of the country and its educational system from the "quality" of posts here and the "ideas" expressed.

Wow. I feel pretty sure what I'm dealing with here. I apologize if me asking you a question to gain some perspective has touched a nerve, Bob. Why not do us both a favor from now on and not deal with my questions. Sorry I asked - just trying to gain some perspective. I know that I can learn a lot from other people here and elsewhere, so I like to ask questions. I rarely write people off - but I note your relatively low post count and realize you might not know much about the people you are discussing things with. I'll stand by my reputation as someone usually pretty fair about issues and more interested in discussing real things and not ripping people or name calling. I've learned a lot here and elsewhere with that thinking. I don't think I'm all that negative, but whatever makes you feel better.

I have no idea what you do. That's why I asked. I am trying to learn perspective and new information, that's why I ask people about what they say. Clearly you say you are plugged in to the process - I'm not. Definitely an "easy chair" perspective from me on this. Looking at what you've participated in, it seems to me that you have a lot to lose and not much to gain by the new scrutiny. Am I wrong in the ASSumption? I think that gives another angle of perspective. Maybe not, but you clearly have been an active participant against this new focus on things.

I agree with you - for most sensible people - the only reason to enter into these posts is to share info, learn something, or just share friendship with people that share some of the same interests. I've made many friends here - don't know about you. Guessing from what I've seen, you haven't made too many - but I could be wrong. I appreciate any information you share - especially the information that is not self-serving and designed to discuss issues. I've read plenty from you that fits that description. I do like much of what you add information-wise. Again - that's why I asked.

 

[bleedingpurple]

........................................................................

you are fooling yourself with this thinking.

About 4 years ago I was in the hospital with no insurance. The total bill from the hospital was around 3,500 dollars

When I questioned the bill as being inflated I was told that the bill was the bill. So I made the phone calls and got them to send me the codes that I was charged for and what it was for.

It was like a fawking telephone bill. I must have made 20 phone calls to billing and supervisors and hospital customer service and anyone else that would listen.

The thing about it was that when I was sleeping they were showing I was taking medicine drips that I was not taking. There were many examples of confusing costs that made no sense.

Either they gave up or got scared I was going to report them to Consumer Affairs in the State Dept

But they backed off the bill down to 1800 dollars.

I paid it.

So who should go to jail for that kind of abuse to patients that are helpless to know what is going on with their care.

Fraud is rampant.

We need to jump this shit and stop it.

We will all be able to get good care if we do.

Hospital profiteering has to stop.

I guess I am lost?? I think we agree? Do you think those extra charges were good old clerical errors? Or were they deliberate mark up charges??

 

[bleedingpurple]

I guess I am lost?? I think we agree? Do you think those extra charges were good old clerical errors? Or were they deliberate mark up charges??

So I guess maybe I was confusing in my first post.. They maybe clerical errors but they are intentional. I though azbob was implying that these errors were accidental because of misnterpretation. They aren't misinterpreting anything they are just trying to get money!!

 

[Duff Miver]

Senator Tom Coburn, MD, R-OK has stated, to President Obama, that there is $30 billion annually in Medicare fraud. How he came to that number, he didn't say.

Obama missed the opportunity to ask Coburn to head up an investigation to save that 30 billion.

It would have been interesting to see how much Coburn actually found. Given that Medicare spends about $800 billion per year, Coburn's estimate of $30 billion would be less than 4% lost to fraud.

Medicare claims about $23 billion, but that is only what they caught, so the real number is higher. There have been some medical practices, mostly in Florida, where every patient, treatment and billing was bogus.

It you think you know of Medicare fraud, you can report it here:

By Phone: 1-800-HHS-TIPS (1-800-447-8477)

By Fax: 1-800-223-2164
(no more than 10 pages please)

By E-Mail: HHSTips@oig.hhs.gov

By Mail: Office of the Inspector General
HHS TIPS Hotline
P.O. Box 23489
Washington, DC 20026

FWIW, back when I was taking care of MILs finances, I caught the local hospital double billing. I reported it to Tricare (the military version of Medicare), but never heard more.

It may have been an accident. Clerical error. Or not.

 

[DOGS THAT BARK]

Obama admin. crackdown on health care fraud leads to 85% more prosecutions

By Kase Wickman
Tuesday, August 30th, 2011 -- 12:15 pm
Rawstory.com

Under the newly reformed health care laws championed by President Barack Obama, it's not only what people pay for insurance that will change, but also the way people pay for insurance crime.

The number of prosecutions for health insurance fraud is already 85 percent higher in 2011 than it was in 2010, thanks to new and expanded health care fraud teams created by the reform, USA Today reported.

Last year, the government recovered a record $4 billion from health care fraud under the nascent laws. This year, the haul could be even larger with the increase in prosecutions.

The Transactional Records Access Clearinghouse, a non-partisan group at Syracuse University that submits Freedom of Information Requests and analyzes the findings, released data on the prosecutions from the Justice Department.

In the first eight months of 2011, the Justice Department has already prosecuted 903 cases, compared to the 731 prosecuted in all of 2010.

If the rate of prosecutions holds steady, TRAC predicted about 1,350 cases this year, just short of double last year's prosecutions.

The increase is due to a crackdown on private agencies, as well as a few large busts that boosted numbers. In February, for example, 111 people in nine cities were charged with Medicare fraud in a connected ring ? the largest-ever federal health fraud takedown, representing $225 million in fraudulent claims.

"The trend certainly looks accurate and on track with our data," Justice Department spokeswoman Alisa Finelli told USA Today, though she said she could not confirm the exact numbers.

Convictions from task force action are also up. Last year, 23 Medicare fraud convictions were made. This year, there have been 24 convictions and rising.

The Justice Department's criminal division Assistant Attorney General Lanny Breuer praised the work of the task forces.

"That's just a stunning number when you see it in the first eight months," he said. "We're just going to build on this model, and we're going to hold those responsible who are stealing from the government."

--WOW Chad -your topic based on speculation is ranked 3rd on goggle search --nubbing Angry Black Lady :lol:

http://www.google.com/search?source...ress&ie=UTF-8&oe=UTF-8&rlz=1I7ACAW_en___US335

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