Monday, June 16, 2008

Medicare Fraud


A high school dropout named Rita Campos Ramirez was able to perpetrate the largest health care fraud against Medicare with the use of a laptop at her home. For four years she electronically submitted bogus claims for equipment and services to the tune of $105 million.

Finally busted, she is now helping the Inspector General bust other doctors and businesses that bilk us taxpayers out of an estimated $60 billion a year. Yes, that's $60 Billion (with a B).

It appears that Miami, Houston and Los Angeles are big fraud cities. HHS investigators discovered that nearly half of 1,581 medical equipment companies they visited in the Miami area weren't open during the day and didn't even have phone numbers.

OK, let's stop right there. Miami only has about 400,000 people (although the entire metro area is over 2.5 million). Doesn't 1,581 medical equipment companies sound excessive for that population size?

The South Florida region bills Medicare more than $2 billion each year for injectable HIV medications. (Most HIV medications are oral, not injectable). That figure is 22 times as high as the amount of similar claims in the rest of the country and is far out of line with a population of 2 million people.

Why is it so hard to shut these crooks down? Pay a high school graduate minimum wage to look at electronic claims for a week and they could use common sense and tell you there is something wrong when a clinic bills for 1000 times more patient care hours than there are in a day. Pick up the phone and call the number. If no one is there, it doesn't exist. Duh!

What is annoying about this is that doctors are terrified of the Office of Inspector General (OIG) coming to their offices to review their charts and make sure the proper code was used. We are told we are subject to fines and jail if we code a 99214 (complex visit)rather than a 99213 (intermediate visit). We are told that the OIG has increased their inspectors and are going after doctors who miscode. I guess we are the easy targets.

Many physicians are just saying no to Medicare patients because the coding requirements are too onerous for the reimbursement. In the meantime, it sickens me to see the health care need and know that tax dollars are going to crooks because it is easy money.

9 comments:

Rich said...

I find it very suspicious given the cities where this fraud happens as to who is committing these crimes.

TBTAM said...

Glad to see Medicare concentrating on the real criminals rather than us docs for a change...

Anonymous said...

Amazing that a high school drop out could out smart medicare in the biggest fraud. At least her mind is being put to better use now.

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I think it was not a good deal because we have to honest, I consider that money is not all i our life, we have to work with conscious in order to don't having consequences at the end.

rxmex said...

There are images able to talk and to say more than thousand words... and this is one of them. Medicare is a fraud, and we are just throwing away our money.

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