Medicare Fraud

When you steal from Medicare and the taxpayer you just might get caught. With an estimated $60 BILLION in losses due to "waste, fraud and abuse" the Medicare system is ripe for an overhaul.

But we have been hearing that for years.

Medicare vs. Bank Robbery

Stealing from Medicare is easier than robbing a bank and you normally get less jail time. Medicare is run like the old west with a shoot first then ask questions later approach to paying for services.

The provider files a claim and if the numbers match up Medicare approves and pays it in three weeks or less. Most of the time if the claim is fraudulent Medicare doesn't catch it until years later if then.

According to Yahoo News . . .

Previously, if a company got caught, its lawyers in many cases would be able to negotiate a financial settlement. The company would write the government a check for a number followed by lots of zeroes and promise not to break the rules again. Often the cost would just get passed on to customers.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.

That's going to leave a mark!

But then on the other hand . . .

"If the government does continue to press its campaign against individuals, we will see the limits of the government's theories tested," said Paul Kalb, who heads the health care group at the law firm of Sidley Austin in Washington. "In my mind, there is a very important open question as to whether individuals can be held criminally culpable or lose their jobs simply by virtue of their status."

Execs with deep pockets are not going to roll over. If the government thinks they have a case it better be a good one.

But smaller firms are a different story.

Onward Medical Supply, a Texas firm, was found to have committed fraud and one of the owners was sentenced to seven years in prison.

Investigators say Onward in 2003 began billing Medicare for medical equipment that patients did not need or never received. Vinitski said she paid kickbacks, as much as $1,000 per patient, to recruiters who then led the potential customers to Onward.

Read more:

Seven years for Medicare fraud with a chance of release in three years or less vs. 25 to life for bank robbery.

Who are we kidding?



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