Whistle-blower Lawsuits Target Medicare Fraud

[Brian Anderson]

Posted a story about a New Jersey lawyer who is making some inroads going after suspected Medicare fraudsters. Stems from a WIRED article about the guy, where it notes that government-initiated prosecutions in 2014 for Medicare fraud generated just 31 settlements and a paltry $88 million in fines. Meanwhile, whistle-blower lawsuits generated 469 settlements worth $2.2 billion in fines in 2014.

Insurance Forums | New jersey lawyer using

 

[vic120]

1) Patient billings that are too regular with no variation in patient visits and follow-up visits always billed on the first allowable day.

Wow Are they Really that stupid??????

 

[seasonschanging]

And they still get away with it. Years ago I got a bill for my father for a co-pay. We had moved from that county 3 years earlier. When I called the office, they told me 'Yes, he was seen last month, but just ignore the bill, it was a mistake.' I called to report the fraud. They were billing for him every single month and he had never been seen by them. They had gotten his info from a hospital stay about five years earlier. They were billing medicare just below the limit that the government bothers investigating for fraud. They look at each individual transaction, not the cumulative total. I was told that unless one single billing went over that limit, they won't bother even investigating.

 

[vdunlap]

My best friend is a systems analyst over at Blue Cross Blue Shield and actually does the system programming for their health care software in that state. What he told me is that private insurers have built in software triggers to detect fraud and are pretty good at it. He told me that Medicare does not have the same extensive software protections that trigger fraud alerts. After witnessing the govt's rollout of healthcare.gov I've no doubt that he's right when it comes to the govt and healthcare software.

 

[goillini52]

60 minutes did a piece on Medicare fraud 25 years ago. A guy turned in this company for Medicare fraud because they were billing his father $600 a month for bandages he could by at the local pharmacy for $6. Medicare did nothing.

 

[vic120]

60 minutes did a piece on Medicare fraud 25 years ago. A guy turned in this company for Medicare fraud because they were billing his father $600 a month for bandages he could by at the local pharmacy for $6. Medicare did nothing.

They prefer to eliminate first dollar cov. to fix this