Medicare fraud

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?


9 replies
  1. Dimsdale
    Dimsdale says:

    On the other side of the coin, could doctors be driven to exploit the system because of inadequate compensation for Medicare patients, analogous to people cheating on taxes when the rates (or confiscation) is excessive?
    Maybe we need a Medicare version of the Laffer curve to show that excessive government control produced either less care or more fraud…

    • crystal4
      crystal4 says:

      Inadequate compensation..ok..then it’s excusable to commit fraud, Dimsdale.
      When my dental plan changed to what the office called “the cadillac of coverages” I had procedures and appts that never happened on my bill…found it happened to my SIL with the same plan upgrade and same dentist and reported him.
      This is done by md’s and hospitals as well-won’t go into the stories.
      Just read about a medical clinic that opened in CT. The md/owner said it was for people with no insurance or high deductibles. he said the check ups and procedures were 40-50% less $$$ than other md’s and clinics.
      Interesting (when there is no $$$ for the middleman).

      • Dimsdale
        Dimsdale says:

        An explanation is not an excuse.? Do you think ?BAMACARE, with the government’s already atrocious record of fraud control, will make this any better?
        ?BAMACARE *is* the middleman.

  2. ricbee
    ricbee says:

    Doctors have been sacrosanct for many years,probably one of the lures of the profession. Not unnoticed by some conmen & crooks who are now engaged in their true professions under a stethoscope.

  3. JBS
    JBS says:

    After reading this post, I know that the Zero does not trust Medicare to reliably answer questions regarding waste, fraud and abuse of the system.
    While Medicare has the data to identify malfeasance, it totally lacks the will to investigate that data, and itself, to fully reveal those who are abusing the system.
    It takes an outside party, the Gray Lady of journalism, to prompt inquiry into Medicare’s own payments. A reasonable person could conclude that while one doctor is named and eleven others are indicted for fraud, there are tens of thousands of other providers who are probably billing Medicare for “excessive” procedures.
    The glaring questions are: Why hasn’t Medicare cleaned its own house? And, with this institutional ineptitude, Zero included, how could anyone claim that an even larger proposed bureaucracy would be any better?
    The theft from the Treasury and Medicare is being accomplished by professional crooks and the continued robbery is being abetted by career bureaucrats.
    And: Where is the $95 million?

    • JBS
      JBS says:

      Or, is the money collateral damage? The cost of doing business?
      Either way, we lose the money, while the criminals get a slap or a trip to club Fed.

  4. Plainvillian
    Plainvillian says:

    It’s all George W. Bush’s fault.? Mr. Obama should put a paragon of moral and fiscal rectitude in charge of the Medicare investigation.? John Corzine is available.

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