Fraud with Medicare isn't new
"Medicare Anti-fraud No Effort" Could we expect anything else from this government besides spending the taxpayers' money with very little if any return? After spending the $77 million on a computer system that probably didn't need fixing and just having Medicare government employees who are already getting paid to do something, to just scrutinize some of the daily Medicare submissions that look questionable on the surface and follow up before they're paid.
Speaking from having former experience working in the health and hospice field in California where fraud can be easily found and prosecuted, if our government was really interested in saving us money. With Medicare's present system of paying the billings and then chasing after the fraud when it's detected later and sometimes after the perpetrators have fled the country. Approximately three years ago, after moving to Idaho from the Los Angeles area, and five years after working directly for a health care and hospice concern, I was contacted by a federal attorney checking on my former employer.While I was still employed, I had written a letter to the Department of Health and Human Services, advising them of some fraudulent practices and even supplying them with company forms as proof to no avail at the time. I again supplied them with materials and discussed how the fraud was being committed. They wanted to question me about the owner's mother being on the payroll while residing in the Philippine Islands. They wanted to know what she was doing for the company without being here. They had me send them copies of what materials I still had. I never received any letters or follow-up from the government attorneys that were handling the case. This particular company was being run by three sisters from the Philippines with 50 some plus employees, mostly relatives and friends.
While I was still employed and working out in the field for this concern, another Filipino-owned home health and hospice agency located in Glendale, Calif., with an office in Eagle Rock and one in San Dimas, was busted by the government for Medicare fraud. At the time, this was one of the largest Medicare fraud presecutions totaling $33.8 million in settlement. Between October 2002 and September 2003, Lourdes "LuLu" Perez and her husband (public notice) fleeced about $40 million from Medicare through a network of paid recruiters and falsified submission documents. When the Perezes were caught, they still had $20 million in their bank account. With the pay and chase style of fraud prosecution being practiced now by our present Medicare government, what money that is eventually recovered after prosecution could amount to only a fraction of what was stolen. How to eliminate much more of the fraud from happening is to assign spot checkers to those companies that have many daily Medicare charges coming into the government for payment. There was once a story in California that all you needed to do was apply to Sacramento for a health care number and you could open your business without having a storefront or any inventory. One medical equipment supplier in Los Angeles was caught billing Medicare for wheelchairs without even owning one.
Within the home health care business, patient referral business comes from the patient's attending doctor. With competition in the home health care business, doctors are paid kick-backs for sending a particular company most of their business. The company in California that I worked for paid a $400 referral fee to a doctor for that doctor's two-hour luncheon date and patient file check at the company office. This helped gain that doctor's feeling of obligation to give his next patient referral to us. You can probably find a form of Medicare fraud in many daily medical transactions with expensive dinners, gambling trips and holiday gifts especially. There are limits set on how much monetary rewards that a doctor can be given within the year. With our present governmental system, there will always be fraud, but much of it could be controlled, stopped and prosecuted.
Bill Singleton is a Coeur d'Alene resident.