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Covering the $60 Billion Medicare Fraud
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Not the Whole Story
Posted by
Michael Reinemer
11/10/2009 12:36:44 PM
As the association that represents the durable medical equipment and service (DME) sector, the American Association for Homecare was alarmed by T...
As the association that represents the durable medical equipment and service (DME) sector, the American Association for Homecare was alarmed by Tompkins' suggestion, which he has since fixed, that all providers in this sector are, by definition, criminals. Neither Tomkins nor his subject, Stephen Stock, spoke with us, and I don’t see any evidence that they spoke to ANY legitimate home medical equipment provider, or "DME."
A year ago, the American Association for Homecare presented to Congress an aggressive 13-point plan to stop fraud before it starts, institute real-time claim audits, increase resources for Medicare to stop fraud, and increase penalties for Medicare fraud, among other recommendations. Some of our anti-fraud proposals have been incorporated into the current Senate health reform bill and proposals former Sen. Martinez introduced last year. Sen. LeMieux, his successor in the Senate, recently introduced a bill, S. 2128, that includes steps that must be taken immediately.
We also have a website devoted to recommendations and links about fighting and reporting fraud: www.aahomecare.org/stopfraud.
The legitimate home medical provider complies with all federal and state regulations, standards, and licensing -- not to mention the exhaustive Medicare documentation and red tape required to get reimbursed. These professionals provide wheelchairs, medical oxygen systems, drug infusion, hospital beds, and other equipment plus the required, accompanying services that help reduce hospital length of stays and lower the nation’s health care costs.
Unfortunately, this fraud is a very old story. So to state the obvious, it's important to get the facts straight and describe the most recent developments and legislation as well as some background, history, and context.
Medicare Fraud
Posted by
Tom Fise
11/10/2009 9:29:48 AM
The story on the $60 billion Medicare scam, sadly, is nothing particularly new—in some respects, it is a story that was just waiting to be...
The story on the $60 billion Medicare scam, sadly, is nothing particularly new—in some respects, it is a story that was just waiting to be written. Vacant storefront addresses, disconnected telephone lines, and either disgruntled patients, or more likely patients whose information was sold to crooks—patients who are never aware that false Medicare claims were filed on their behalf--have become familiar stories, in South Florida and elsewhere. For the last 15 months, we’ve been trying to get federal action on a bill, H.R. 2479, that would stop fraud and abuse at least in the area of orthotics and prosthetics (it would have stopped the judge with 4 natural limbs from receiving notice that Medicare had paid for his artificial limbs). Just one of the simple provisions of this bill—if a state has a statute that requires providers to be licensed, Medicare can’t pay federal dollars to people who violate that law. Florida does have a licensing statute for orthotics and prosthetics—if H.R. 2479 had been in force, Medicare would not have paid any of these bogus claims. But guess what—even after the 60 Minutes story broke, the “independent” Congressional Budget Office looked at H.R 2479 and said it would not save $1—despite that fact that it would have thwarted those fraudulent claims! Makes you wonder if feds really want to change things—to acknowledge that there are ready answers to these problems sitting right in front of them. Here’s an ad that ran last Thursday in Roll Call, delivered to every office in Congress:
http://www.aopanet.org/Roll_Call_Ad.pdf
Tom Fise, AOPA
tfise@aopanet.org
Whistleblowers and Medicare fraud
Posted by
Deborah Duffy
11/9/2009 11:43:05 AM
Journalists who cover healthcare fraud should be aware of a federal whistleblower law known as the False Claims Act. Sometimes government investi...
Journalists who cover healthcare fraud should be aware of a federal whistleblower law known as the False Claims Act. Sometimes government investigators are aware of someone committing Medicare fraud but can't talk about it because the cases are "under seal," meaning the cases initially are kept secret by law from the public and even the companies or individuals being accused of fraud. So if reporters get only "no comment" from government officials or those officials "go dark," there might be a reason other than the usual unwillingness to talk to the press.
The False Claims Act has become the government's strongest and most used law to attack healthcare fraud (more than $14 billion from whistleblower cases alone). At least 26 states have similar false claims laws, most with whistleblower provisions. Under the False Claims Act, whistleblowers may sue anyone committing fraud against the government and recover damages on the government's behalf. These "qui tam" lawsuits are kept under seal to give the government time to investigate the whistleblower's allegations before the defendants destroy or cover up evidence. The whistleblower is entitled to 15 percent to 25 percent of the funds recovered if the government joins the case and up to 30 percent if the government doesn't pursue the case and the whistleblower recovers funds for the government on his/her own.
I work for Phillips & Cohen LLP, a law firm that focuses exclusively on representing whistleblowers in cases involving fraud against the government. Our website has a lot of information about how the law works. See: http://www.phillipsandcohen.com/CM/FalseClaimsAct/howks_f.asp. For a list of states with whistleblower laws, see http://www.phillipsandcohen.com/CM/StateFalseClaimsLaws/StateFalseClaimsLaws152.asp.
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