Remember when the President told us that Obamacare would cut gabillions in Medicare waste, fraud and abuse? Apparently, in a secret backroom deal, the President deputized the Wall Street Journal to perform this task.
Last year the WSJ did a series detailing certain irregularities it had discovered by digging through Medicare’s claims database. In doing so, it identified a doctor whose billing practices seemed more than suspicious. At the time, the WSJ did not know the identity of the doctor as Medicare refused to provide names. But, here is what the WSJ found out. The doctor in question,
performed or supervised 29 separate sleep, neurological, ultrasound and other diagnostic tests on her patients. Looking at all 811,785 providers in the database, the Journal found that no other provider of any speciality conducted all 29 of those tests in 2008.
Looking at that, one could conclude that the doctor was either incredibly talented, or something was definitely not on the up and up.
This week, the U.S. Attorney’s Office for the Eastern District of New York indicted this doctor…Dr. Emma Poroger, and eleven other health care providers for (in separate schemes) fraudulently billing Medicare to the tune of over $95 million.
Another doctor referred to in the WSJ article entered a guilty plea in May to Medicare fraud, notably, performing services that were not necessary, and billing for services not performed. Another was suspended by the Texas Medical Board, and a third, under orders from the Oregon Medical Board, is no longer allowed to perform surgery unless he is under the supervision of another doctor. Were I to need surgery, I am not sure this last doctor would be my first choice.
Call me cynical, but, I am left wondering why Medicare, which has access to its own database on a daily basis, couldn’t have figured this out on its own? And, perhaps, since this database exists, would it be too much trouble to ask Medicare to review it before they pay a claim?