Who is Committing Healthcare Fraud?

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2 Responses

  1. Jon May says:

    And yet they have only scratched the surface. A major area of fraud is unnecessary surgeries. But this is almost impossible to police. First of all, the procedure is actually performed. Second, how do you determine that the physician lied about necessity in an individual case–the fact that this doctor finds a reason to replace the knees of everyone who walks through the door, or never saw an artery that didn’t need a stent is not sufficient to make a case. Of course there is nothing new here–at one time every menopausal woman needed a hystorectomy–then C sections became popular. What’s new are all the parts that can be replaced. So long as we reimburse for procedures performed doctors, will find reasons to perform these procedures. And as long as companies are willing to provide benefits to doctors to prescribe their medicines or implant the company’s devices, doctors are going to take them. The easiest thing in the world is to rationalize self interest.

  2. Ed Martin says:

    I attempted to defend a durable goods provided on medicare fraud charges.  Trouble is my client was guilty.  The FBI and state Medicare Investigator investigated the case and determined the her business had defrauded the system of at least $1.2 million.  The investigators could not find out how she was doing the fraud until in discovery I reviewed their seized records.  The client advised the records would prove that she did nothing wrong.  That was a lie.  In the records was a document with a fax number on it and the number went back to a hospital and the hospital was found to be the source of the names for the fraud to take place.  My client's mother worked in the admissions section of the hospital and was providing names of patients admitted to the hospital.  The bank records showed that the mother was paid finders fees worth over $27,000.  My client was indicted and plead guilty and recevie a 10 year sentence (well deserved) and the government seized her assets including the $1.2 million.