Why not equip the auditors to examine 100% of the transactions in minutes rather than weeks? 95 of the fortune 100 have used data analytics to independently verify the accuracy of company transactions. The medicare system needs to be run like an accountable business! We could catch "Tony" by reviewing accounts based on procedure codes submitted vs. national averages: eg; are more expensive procedures being done than normal? Once we catch "Tony" we take his list and run every person on it compared with every other transaction in the whole healthcare system. That gives you every other illegal transaction from fraudsters who bought the same list as "Tony". The Pentagon used ACL (see www.acl.com) to recover $1.4 Billion USD in defense fraud last year. Does the government care more about bombs or hospitals? Lets use the same technology to clean up healthcare now! There is enough waste in the system to provide coverage for every uncovered citizen in the country! Provide coverage for the poor by catching crooks, what's wrong with that?
Why not equip the auditors to examine 100% of the transactions in minutes rather than weeks? 95 of the fortune 100 have used data analytics to independently verify the accuracy of company transactions. The medicare system needs to be run like an accountable business! We could catch "Tony" by reviewing accounts based on procedure codes submitted vs. national averages: eg; are more expensive procedures being done than normal? Once we catch "Tony" we take his list and run every person on it compared with every other transaction in the whole healthcare system. That gives you every other illegal transaction from fraudsters who bought the same list as "Tony". The Pentagon used ACL (see www.acl.com) to recover $1.4 Billion USD in defense fraud last year. Does the government care more about bombs or hospitals? Lets use the same technology to clean up healthcare now! There is enough waste in the system to provide coverage for every uncovered citizen in the country! Provide coverage for the poor by catching crooks, what's wrong with that?
Headline. Florida Medicaid Fraud Control Unit Closes 1270 cases.
Subheading. But Only Seven percent (88 cases) result in Convictions or Settlements.
The other 1182 cases (93 percent) were unfounded, lacked evidence or closed for various reasons. These numbers are from July 2005 through February 2007 and show cases were opened without a review to determine the validity or viability of a complaint or allegation.
This has been an on-going problem in Florida and was first brought to our attention on January 29, 2003. Florida AG Charlie Crist, who at the time was overseeing the MFCU, received a letter from the U.S. Department of Health and Human Services (HHS). The letter states the MFCU was cited for not providing complete and accurate case information, employing individuals who did not meet established minimum qualifications and ten other deficiencies. The Florida MFCU was placed on ?high risk? and probation for a year.
On December 29, 2008 in the Annual Report on the State?s Efforts to Control Medicaid Fraud and Abuse the question is finally answered to why the number of cases unfounded or had no evidence were high. This was taken from the report.
?Prior unit policy called for the opening of an operational case, whenever possible, based upon the mere receipt of a complaint. There was little, if any, review to determine the validity or viability of a complaint or an allegation. Case openings will now occur only when there is a criminal or civil predicate that warrants further investigative activities.? Submitted to Governor Charlie Crist on December 29, 2008. see Page 3 Under "Complaints" http://ahca.myflorida.com/docs/2008_Fraud_and_%20Abuse%20Binder_signed.pdf
I was surprised to learn the MFCU had been opening thousands of cases without evidence for at least the last six years. I am not an attorney, but it would seem to violate a person?s constitutional right to be arrested without probable cause or verified evidence.
In addition, these innocent people would be used as a pawn to increase the number of arrests made by the MFCU. The increased arrests would help the MFCU get off probation, obtain additional federal funding, receive media coverage and help elect Charlie Crist.
Information obtained in this comment can be found in the my florida, Auditor General section.
Oh course, private insurance has far more of this going on than does any government program. That's one reason your rates are so high - that and their greed.
Concerning private insurance companies having far more fraud and abuse problems than Medicare. I don't think this is accurate, most private insurance companies require proof of medical need documentation be provided to them on a prior approval basis before processing and paying a claim. Medicare does not require prior approval before processing a claim. Also, Medicare is a much larger bureaucratic entity, which has practically unlimited funds, being an etitlement program provided through government at tax payer expense. Just consider the even greater amount of fraud once government assumes control of one sixth of our economy by imposing a government / universal health plan.
A modest proposal: investigative journalists should no longer waste their breath and ask 'why did you not uncover this fraud?'. From the lowliest township clerk, to the head of the SEC, the standard answer is always 'we're underfunded, understaffed and overworked'. How many more people, and how many additional billions, would it take for these employees (of ours!) to actually do the job they've been hired to do??
I wonder if the three dolts that do field inspections bother to look in the phone book to obtain addresses of these medical suppliers. You go to the location during office hours, knock on the door. If no one answers you place them on the "do not pay list". No illigitimate medical suppliers will ever protest this and bring attention to themselves. If 85% of them are phoney it shouldn't be too difficult. And how much do they pay this lady who hasn't thought of doing this? And if we do pass a national health bill we can let these idiots hire the fraud security task forces needed to protect the billions that will be spent on this farse. I can't believe this nightmare.....or the people that are in favor of it....
About 10 years ago after being seen by a cardiologist for a routine outpatient procedure, the medicare billing statement I received included a non-existant pace maker implant and hospital stay. I contacted the number on the medicare statement to apprise them of this and encountered a "oh thanks for telling us" and end of story kind of attitude. I actually had to insist that they take a report of these facts starting with my name! I have since learned of many others in my small community who have encountered bogus charges on their medicare statements as well. Most all and any agencies funded by tax payer dollars are in desperate need of major accountability and regulation oversight. This is a fact because we have seen the reality of so-called self-regulation. We are a capitalist society whose very nature is based on greed, not equity. Consider the blatant expose in American Samoa.
We did not watch 60 Minutes as we don't watch much TV...too biased. I ran across this story while doing some surfing for a medical problem. Enjoyed the many informative comments posted here. The time is ripe in the U.S. for a real "across the board change". Maybe a "Common Sense Integrity Party"? You betcha! I know, I know. A third party wouldn't stand a snow balls chance in hell of surviving the wrath of the D.C. power brokers.
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Erik B
Erik B
Headline. Florida Medicaid Fraud Control Unit Closes 1270 cases.
Subheading. But Only Seven percent (88 cases) result in Convictions or Settlements.
The other 1182 cases (93 percent) were unfounded, lacked evidence or closed for various reasons. These numbers are from July 2005 through February 2007 and show cases were opened without a review to determine the validity or viability of a complaint or allegation.
This has been an on-going problem in Florida and was first brought to our attention on January 29, 2003. Florida AG Charlie Crist, who at the time was overseeing the MFCU, received a letter from the U.S. Department of Health and Human Services (HHS). The letter states the MFCU was cited for not providing complete and accurate case information, employing individuals who did not meet established minimum qualifications and ten other deficiencies. The Florida MFCU was placed on ?high risk? and probation for a year.
On December 29, 2008 in the Annual Report on the State?s Efforts to Control Medicaid Fraud and Abuse the question is finally answered to why the number of cases unfounded or had no evidence were high. This was taken from the report.
?Prior unit policy called for the opening of an operational case, whenever possible, based upon the mere receipt of a complaint. There was little, if any, review to determine the validity or viability of a complaint or an allegation. Case openings will now occur only when there is a criminal or civil predicate that warrants further investigative activities.? Submitted to Governor Charlie Crist on December 29, 2008. see Page 3 Under "Complaints" http://ahca.myflorida.com/docs/2008_Fraud_and_%20Abuse%20Binder_signed.pdf
I was surprised to learn the MFCU had been opening thousands of cases without evidence for at least the last six years. I am not an attorney, but it would seem to violate a person?s constitutional right to be arrested without probable cause or verified evidence.
In addition, these innocent people would be used as a pawn to increase the number of arrests made by the MFCU. The increased arrests would help the MFCU get off probation, obtain additional federal funding, receive media coverage and help elect Charlie Crist.
Information obtained in this comment can be found in the my florida, Auditor General section.