Meet Medicare Fraud's Whistleblower
Robert McCaslin is a man of few words … but many scruples.
"Just the way I'm wired, I guess," he said. "It's just that simple."
Which is why he lost sleep over major taxpayer fraud he unearthed while working in billing at the Houston Hospital District, CBS News investigative correspondent Sharyl Attkisson reports.
"It's an attack on the whole system," he said. "Everybody that pays taxes it involved in this."
McCaslin caught the hospital billing Medicare for accident victims, even if the patient had private insurance that was supposed to pay. The hospital also billed Medicare for prisoners, even though by law, they're not covered.
When McCaslin alerted his bosses, he was surprised to discover they were in on it.
"In one of the meetings with the manager, they said 'that's just the way they did it here.' That was their procedure," he said.
It's not just a problem in Houston. Across the nation, hospitals are sending Medicare improper and fraudulent charges. It's costing taxpayers big time: nearly $11 billion a year.
The government started a pilot program and sent private auditors to comb through hospital bills in three states (California, Florida and New York), looking for Medicare rip-offs.
In one year, they were able to make hospitals pay back an astounding $247.4 million. That's in just three states.
The audits are supposed to expand to all 50 states in March.
"Imagine what will happen when it rolls out nationally. The amount of money that can be saved," said Leslie Paige of Citizens Against Government Waste. "And unlike a lot of things, this money goes back into the health care trust fund, which lengthens its life and shores it up."
Read more on Medicare fraud on Couric & Co. blog.
Without serious help, the trust fund that pays Medicare hospital bills will go belly up in 2019. But not surprisingly, the hospital lobby is trying to put on the brakes on the audits, saying while they support the idea, the program is flawed and unfair.
Meantime, people like Robert McCaslin will be out there fighting one hospital at a time.
He helped the Justice Department build a fraud case that ended with the Houston Hospital District giving taxpayers a giant refund.
"The hospital paid back approximately $15 million," he said. "I got $3 million."
That's right ... McCaslin got a windfall he never expected. Under federal law, whistleblowers can get a piece of the settlement. Now he has the money to drive a nice new car. And in his typically understated fashion, he told us how he planned to make up to his wife for all the sleepless nights.
"We're going to Paris for Valentine's, uh, weekend," he said. "And that will be nice."
A win-win situation for taxpayers - and the man who didn't say much, but did the right thing.
