Medicare Does Not Care About Fraud
In a practice with a large geriatric population such as ours, you grow used to the endless attempts at Medicare Fraud. For decades, we have filtered out bogus equipment demands, insanely expensive scam testing, various compounded pain creams and other attempted crimes which are a marvel of inventiveness.
How ingenious are they? All of them try to get you, the physician, to sign for the overpriced worthless compounded chemicals or equipment, thus making you an accomplice. “We are doing nothing wrong,” they exclaim. “We merely follow doctors’ orders. Your patients,” they will falsely claim, “asked for these helpful treatments.”Here is the dilemma for practices: The typical geriatrics practice is inundated by faxed requests from various legitimate Home Health agencies and pharmacies. Diabetes supplies are a particular target. We regularly receive such requests from pharmacies such as Walmart, CVS and Walgreens to correctly code and sign for Medicare diabetes testing supplies. Yet, there are a lot of bogus companies which have similar appearing faxes, slipping into the fine print a request to approve some incredibly expensive useless compounded pain creams and joint braces. These extra bogus faxes tend to blend in with legitimate requests.
More recently, we have seen an increase in requests by phone and fax for private patient information, masquerading as originating from Johns Hopkins or the Mayo Clinic. Since patients often travel to these centers for second opinions, it appears legitimate on the surface. If you call the patient, however, you learn the patient has had no contact with these centers. Thus, unless your staff is totally on its toes, you could commit some real HIPAA violations.
The comment I hear is: “You need to report it!”Yeah… Good luck with that…Medicare has a 1-800 number for fraud. It even promotes a website to report the fraud.
Yet the reality is they don’t want to hear from doctors or medical offices. They say they want to hear from patients. But they never really investigate anything. I’m sure Medicare investigators would claim they are overwhelmed, but I beg to differ.
It is not like these companies are hiding. They do their fraud in open daylight. Any investigator could create a criminal case within hours. If you wanted to pay me a finder’s fee, I could do it in thirty minutes.
These scams do not even try to hide. The faxes and fax numbers remain the same for years.
Every few years, Medicare pretends it is getting tough and goes public about fraudulent over-priced medical equipment and compounded bogus drugs. Yes, Medicare is shocked… SHOCKED… to discover that companies are supplying overpriced shoddy unnecessary equipment to patients at Medicare’s expense. “MEDICARE WILL NOT TOLERATE FRAUD!”Those of us in practice watch the dog and pony show as Medicare promises bold action. Then Medicare dozes off in its comfy chair and lets the criminals run wild again. The same scams continue. Nothing changes. The criminals expend virtually no effort for their rewards. If you try to complain, Medicare will never call you back. Medicare truly only provides lip service to fraud reduction.
At the same time all of this Medicare fraud is occurring for useless items, it causes insurers to crack down on supplies even for diagnosed conditions. You wouldn’t believe the hoops I jumped through to get my physician to prescribe diabetes testing supplies to help me manage my T2 diabetes! It took over a year, during which time I paid out-of-pocket for these items which the insurance company supposedly covers.
A little off-target, but Mozilla warned me about apps our patients use. One for ON-LINE PSYCHOTHERAPY (!)
claims to help people manage anxiety and depression:
“…name, home address, billing address, shipping address, email address, home, work, and mobile telephone numbers, country, date of birth, credit or debit card number (for payment purposes only), driver’s license number, audio, images, and videos of you, Social Security Number, your medical history, health insurance subscriber information, health information, racial or ethnic origin, religion or religious beliefs, criminal background checks, criminal history, political organizations or beliefs, sexual orientation or preferences… your medical condition, treatment options, physician referrals, prescriptions, and lab results… Information stored on your mobile device, including in other applications… photographs, audio and video clips, and health information.”
Sorry, but you’ve got it backwards. I showed my attorney son a stack of these faxes and asked “Why doesn’t Medicare go after these bastards for fraud?” He read them over and said “They aren’t committing fraud by sending them to you. But if you approve any of them, you are committing fraud.”
EVERYTHING IS A BUSINESS MODEL…GOVERNMENT, MEDICINE, FRAUD, CORRUPTION,
SCAMS. MARRIAGE, DIVORCE,DRUGS legal and illegal.. FOLLOW THE MONEY.WHO BENEFITS
HOW MANY IN GOVRRNMENT ARE PART OF THESE SCAMS….
Back in the day when I worked for our state health plan our administrator tried to report a fraudulent actor. He was told that the minimum amount of fraud the feds would investigate was $50 million. I can’t verify but it fits your report.