Archive for the ‘Healthcare’ Category
Greg Gordon reports for McClatchy:
During a meeting that was secretly recorded, a salesman for Reliance Medical Systems promised that within a month or two of joining its illicit kickback scheme, spinal surgeons could collect enough money to pay for their kids’ college educations, Justice Department lawyers charge.
Taxpayers were the multimillion-dollar sugar daddies in this plot, initially uncovered by two doctors-turned-whistle blowers who could collect a sizable reward under a law compensating those whose tips lead to federal financial recoveries.
In May 2010, a Michigan spinal surgeon bought into one of the schemes that aimed to circumvent a federal law barring device manufacturers from making payments to induce physicians to use their products, the government alleges in two suits filed under the federal False Claims Act.
One suit charges that Dr. Aria Sabit, who now lives in Birmingham, Mich., and Sean Xie, who was studying under Sabit, each paid $5,000 to become an investor in Apex Medical Technologies, a distributorship for Southern California-based Reliance. That month, the government alleges, each got back $20,117 from Apex – a return of more than 400 percent in 30 days’ time.
That was just the beginning.
Over the next nine months, Apex paid Sabit $264,957 while he repeatedly used Reliance products for spinal fusion surgeries, some of them unnecessary – and $483,570 before he stopped using Reliance equipment, the suit said. Sabit also presumably collected handsome physician fees for his services.
Meanwhile, Community Memorial Hospital in Ventura, Calif. paid Apex $1.4 million for the cost of the implants that Sabit used in his surgeries.
The hospital, in turn, billed Medicare – and federal taxpayers – for nearly all of those devices.
A second California-based Reliance distributorship, known as Kronos Spinal Technologies, made improper payments to two other physicians, Drs. Ali Mesiwala and Gowriharan Thaiyananthan, the suit said. Kronos was based at the same Jacksonville, Fla., address as Apex, it said. One of the distributorships’ owners allegedly was recorded as saying that the scheme was formed as part of a plan to “get around” the federal Anti-Kickback Statute, it said.
In July 2011, Mesiwala was recorded as stating that there was an “expectation” that doctors who bought into the distributorships would be using Reliance equipment, the suit said. He also was quoted as saying: “If you truly are in this to make money and you have a finite time limit to do it, I don’t know a better way to do it.”
Kronos paid its investor physicians $4.9 million from August 2007 through September 2012, the government said. . .
The South is alone in having a higher proportion of adults without health insurance after Obamacare than they did before. This is thanks to the GOP state governors and legislators who went to extraordinary lengths to make sure that the poor would not have access to healthcare. As I have observed, you can usually predict GOP policy if you assume the GOP hates the poor and will do everything they can to attack and undermine the poor. In this case, it required not extending Medicare in the states (which was essentially free), refusing to set up health exchanges (Kentucky is an exception—and indeed, the number of uninsured in Kentucky dropped sharply), and refusing to inform people about benefits under the Affordable Care Act.
The above chart is from this article, which attempted to identify the remaining uninsured as of June 2014.
The simple answer is that Medicare was not reviewing its billing data and seemed to have little interest in stopping fraud. Charles Ornstein reports in ProPublica:
A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions.
Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.
And then there was this: The sessions were often being performed by obstetrician/gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled.
So Medicaid began cracking down, and spending plummeted after new rules were implemented. In July 2012 the program stopped paying for group psychotherapy altogether for residents of nursing homes.
Yet Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows.
Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total.
Among the highest billers for group psychotherapy in Illinois were three ob/gyns and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.
“That’s not good,” Eagleson said when told of the Medicare numbers.
Medicare’s recent data release has led to a string of analyses showing how waste and fraud is inflating the nation’s bill for health care. This work has echoed the findings of ProPublica’s investigation last year into Medicare’s prescription drug program known as Part D, which had fewer barriers to waste and fraud than other government health care programs – and was making less effective use of its own data.
Of the Illinois ob/gyns billing for group psychotherapy, . . .
Some of these physicians should face criminal charges for fraud and also lose their license to practice medicine.
They continue walking the earth even after they have been completely exposed as counterfactual. As Maher says:
What they do is they pass a zombie lie down to dumber and dumber people, who believe it more and more.
Hank Paulson may be over the one about climate change being a hoax, but it’s still good enough for Sean Hannity. Who then gets quoted by Michele Bachmann. Who forms the intellectual core of the thinking of Victoria Jackson. And when you think the zombie lie has finally gone to die at the idea hospice of the absolutely stupidest people on Earth, there it is being retweeted by Donald Trump.
But that’s just the summation of a very good rant about all the zombie lies about Obamacare. Maher goes through the list—lies that have been solidly refuted but never acknowledged by the GOP, which simply moves on to the next round of lies, leaving their litter of lies to blow around and soil our daily lives.
The eruption of the VA scandals showed clearly that the government does a poor job of investigating its programs. And now Medicare has been found to simply accept large-scale fraud, seemingly making no effort whatsoever to detect and punish fraud—until newspapers write stories about it. Charles Ornstein has an infuriating article in ProPublica:
The fraud scheme began to unravel last fall, with the discovery of a misdirected stack of bogus prescriptions — and a suspicious spike in Medicare drug spending tied to a doctor in Key Biscayne, Fla.
Now it’s led to two guilty pleas, as well as an ongoing criminal case against a pharmacy owner.
Last year, ProPublica chronicled how lax oversight had led to rampant waste and fraud in Medicare’s prescription drug program, known as Part D. As part of that series, we wrote about Dr. Carmen Ortiz-Butcher, a kidney specialist whose Part D prescriptions soared from $282,000 in 2010 to $4 million the following year. The value of her prescriptions rose to nearly $5 million in 2012, the most recent year available.
But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher’s attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. But instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities.
Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show.
In February, the U.S. Attorney’s office for the Southern District of Florida charged Maria De Armas Suero, who had been a secretary at Ortiz-Butcher’s Island Clinic from March 2011 to September 2013, with 11 counts of conspiracy, fraud and aggravated identity theft.
Suero subsequently agreed to plead guilty to two counts of conspiracy and identity theft. In a recounting of her wrongdoing, called a factual proffer, she acknowledged using Ortiz-Butcher’s paper prescriptions to “create fraudulent scripts for numerous Medicare beneficiaries…The prescriptions falsely represented that the Medicare beneficiary was seen by [Ortiz-Butcher] and that the listed prescriptions were medically necessary.”
Suero acknowledged that she was paid $100 for each prescription she generated. . .