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Fighting Medicare Fraud

By Lawayne Childrey | Published 05 Sep 2011 02:12pm | comments

As Washington plans to slash most government programs, one is slated to grow. The federal government is spending more than ever to combat Medicare and other medical fraud. Ana Radelat has more on the effort to fight fraud in Mississippi.

Each year, medical fraudsters steal at least seventy-billion dollars from the federal government. Probably a lot more. Most of it comes from fraudulent bills submitted by doctors, hospitals, pharmaceuticals and medical equipment salesmen. A recent Medicare scam in Mississippi involved physical therapy facilities.

JACKSON: “They basically pay the physicians for use of their provider number and they bill for services that aren’t rendered.

Derrick Jackson is a special agent at the Department of Health and Human Services’ Inspector General office in Atlanta.

JACKSON Over the last five years we’ve had fourteen convictions in the area of physical therapy, totaling over the seventy three million dollars.”

The owners of Statewide Physical Medicine of Moss Point were sentenced to ten years in jail and fined about eighteen million dollars. Jackson says new scams crop up all the time.

JACKSON: “As we started to get a grip on the physical therapy fraud that was going on in the state, another fraud trend has popped up and that is now hospice. Mississippi has a serious problem with hospice fraud.”

Jackson says Mississippi’s 117 hospices are meant to shelter terminal patients. But they discovered hospices were billing Medicare for hundreds of thousands of dollars for patients that aren’t terminal. Billings to Medicare for hospice care in Mississippi were one hundred and ninety million dollars in 2009 and one hundred twenty million dollars in 2010.

JACKSON: “Based on those figures you can see that billing for hospice services is a profitable fraud to get involved in.”

There are three federal investigators in Jackson ferreting out medical fraud in the state. But the problem is nationwide. Patrick Burns is spokesman for Taxpayers Against Fraud, a Washington non-profit that helps whistleblowers.

BURNS: “Once you discover how to game the system in one hospital or one doctor’s office in one part of the country you can then take that fraud and essentially duplicate it again and again and again.

He says anyone with a good laser printer and a post office box can defraud the federal government. But the biggest scammers are major hospital chains and pharmaceutical companies.

BURNS: You might figure out in a small office in Oklahoma how to upcode pneumonia from a four hundred dollar charge to a four thousand dollar charge, well if that works in a doctor’s office in Oklahoma, that works in a hospital system across the nation and billions of dollars are Hoovered out of the economy.”

Shortly after President Obama took office, the administration set up a Health Care Fraud Prevention and Enforcement Team, known as HEAT. HEAT pairs the Justice Department with the Office of Inspector General at the Department of Health and Human Services
While most federal programs will shrink under a recent budget deal Congress approved to avoid a government default, money to combat health care fraud will nearly double next year.

It’s been money well-spent: every dollar spent on enforcement brings four dollars back to the U.S. Treasury. HEAT Initiative Administrator Spencer Turnbull says the new focus on rooting out fraud is working.

TURNBULL: “We’re really able to get in and bring a lot of folks to justice than has historically been the case.”

Yet Burns says there still aren’t enough federal resources to take on the biggest scammers.

BURNS: “They are willing to invest a million, five hundred million dollars a year in legal fees. Because if you’re making three billion a year of off fraud and all you have to do is invest five hundred million dollars to keep DOJ at bay, its an unequal army. It’s like Custer fighting the entire Sioux nation, and we know how that turned out.”

And that’s with the extra money.

Burns says Congress remains beholden to the health care industry, and that’s why federal fraud fighters will never have enough resources.

From Capitol News Connection, I’m Ana Radelat, MPB News.

 

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