Health care fraud rampant!
In 2012 Tony West, an assistant attorney general in the Justice Department’s civil division said of the False Claims Act, also known as “Whistle-blower” cases are one of the “primary tools” used to fight fraud. Specifically health care fraud.
“We’ve made health care fraud such a high priority; we’ve been using this tool very, very aggressively”, he said. Three years ago, the government recovered $5 for every dollar spent fighting fraud. Recently, that increased to $7 for each $1. Government agencies, including the departments of Justice and Health and Human Services, have begun combining resources. That makes their efforts more efficient and better targeted, West said, and means that there are more resources available…
Over the last 20 years, whistle-blower cases have dramatically increased so they average about three times as much money back to the government as non-whistle-blower cases.
Under the False Claims Act, the government can recover up to three times the amount fraudulently taken by a company, according to Justice Department spokesman Charles Miller. The people who come forward to uncover the fraud in healthcare get a percentage, which is often tens of thousands of dollars.
See Youtube video: “Padding the bill” http://www.youtube.com/watch?v=CpwdF7BCnoI
Large health care fraud cases often involve pharmaceutical drug companies either falsely advertising a product or marketing it for a use that hasn’t been approved by the FDA. This kind of fraud is rampant today.
The crime of medicare fraud is bigger than drug business in total volume ( see Youtube: http://www.youtube.com/watch?v=kG6hu-t080w&feature=relmfu).
“Healthcare fraud by doctors and hospital administrators, and others in positions of trust is perhaps the most despicable type of fraud we see”, says Nathan Vicks of Charlotte, N.C.a private fraud investigator, who in some cases go through the garbage of doctors and hospitals to uncover crimes. “We find all sorts of strange things with respect to billing of patients. We are getting close to filing lawsuits against one of the more prominent hospitals in Charlotte soon”, he said. Vicks would not elaborate on the details since the investigation in the crimes committed by the doctors and hospitals is still ongoing.
“What we need is billing clerks, nursed and hospital administrators to come forwards about what they know about fraud committed against patients in hospitals and nursing homes”, says Tammy Franco of Charlotte, a consumer advocate. “I would urge people who work inside hospitals to photocopy documents which indicate fraud and post them on line for everyone to see”, she said.
Most whistle-blowers try to report fraud to company managers first and go to the government when they grow frustrated when the fraud continues, West said. “We find that their information is usually very credible,” he said, but “we reject more cases than we accept. We’re pretty choosy.” Justice Department action can have long-term consequences for a company, including bankruptcy, West said. That means Justice will try other steps beyond lawsuits and tend to focus on large cases that have the greatest impact, he said.”It’s not just the big cases that attract our attention,” West said. “We look at whether public health is at risk.”
“It is also smaller cases of fraud that they should investigate, but they don’t for lack of resources. The problem is employees are reluctant to come forward for fear of losing their jobs, so they often times do not say anything, even in those cases where a patient gets hurt or injured”, says Kelly O Donald of Charlotte. “If you ask nurses and CMA ‘s they all have stories of what they see doctors and hospitals do wrong. We need them to do what’s right and come forward” she said.
“There are others in healthcare such as internet technology or IT who could expose fraud. One IT manager said recently that his physicians network was using government monies to upgrade to electronic billing while also charging patients for the service. He agreed that was unethical, but went along with it anyway. Its people like this we have to reach and convince to do the right thing and collect the evidence we need to stop this kind of abuse by physician networks”, says Marty Jones of Charlotte.
The entire healthcare system is loaded with fraudulent billing, up-coding fraud.
This is limited to just doctors in hospitals. Dentists also engaged in fraud and abuse.
In a 2010 case, Justice targeted a group of dentists and recovered about $25 million.”They were engaging in practices that were absolutely barbaric,” West said. In one case he noted that one small child received 16 unnecessary root canals in one sitting, he said.
The motive was money and greed in all these case.