4 ms·
Feds take down $1B Medicare fraud scheme
- kcorbitt 8y agoAh, so that’s why I’ve been getting so many robocalls that start with “You’ve been qualified to receive a medical-grade brace”.
- tlrobinson 8y agoIronically I just got one of these calls yesterday saying it was my "final chance" to receive my medical-grade brace. Final chance indeed.
- techntoke 8y agoEverytime they called me I would try to keep the conversation going telling them I had pain, and then explained that I had a pain in the arse from them calling me all the time.
- imperio59 8y agoI'm starting to understand why medicare is going bankrupt... Glad these guys got caught and taken down.
- randomacct3847 8y agoMedicare is notorious for being rife with fraud and waste. This ring is far from the only one. This includes mom-and-pop doctors who “upcode” certain procedure codes so that they get paid more. There’s obviously very little the govt can do to check or know. That kind of stuff happens all the time. Like I wonder if the govt is even doing basic anomaly detection on claims data to catch these things...if a ring is getting away with $1bil it makes me think no. Also...there got to be so much opportunity to build a company around selling a DS tool to the government or insurance companies to help detect and stop medical fraud.
- Consultant32452 8y agoMy governor famously ran one!
- clarkmoody 8y agoWith complexity comes opportunity.
- danvayn 8y agoWhat are the common signs of this and where should I submit a complaint if I see them? Our longtime family doctor seems to make way too much money doing what he does just giving standard health checkups to the elderly.
- prostoalex 8y ago> a DS tool to the government or insurance companies Insurance companies have actual fraud departments with investigators clinging onto every hint of over-prescribing, over-billing, over-testing or repeat visit inflation. Medicare, on the other hand, has low administrative expense that's constantly touted as some kind of incredible achievement when compared to those "bloated" private insurers.
- dantheman 8y agoIn fact fradulent spending increase the total spend so it lowers the administrative expense.
- tehlike 8y agoIsnt the 80/20 rule is a disincentive for insurance companies to go after fraud?
- lotsofpulp 8y agoTheoretically, a competing insurance company that reduces fraud can offer lower premiums. In reality, this is thwarted by having significant portions of the population locked up in employer provided health insurance so they can’t shop around, although the employer is sort of shopping around for them. It would be much better if everyone was dropped onto healthcare.gov.
- ronnier 8y agoWhy are the criminals not named?
- simonh 8y agoThe accused. A fine distinction to make in conversation perhaps, but an important one.
- ronnier 8y agoAgreed. But not always so consistent as usually we have names and photos, though I’m seeing it less and less lately.
- joe_the_user 8y agoIt's completely standard for those merely accused of crimes to have their names spread boldly across the news in America. Nothing protects the accused in the court of the press and public opinion. I assume if the accused aren't mentioned here, it's a matter of their having good public relations and good lawyers.
- mjevans 8y agoI assume it's because they can afford lawyers that actually requested the information be sealed until they're found guilty.
- scandinavian 8y agoThey were charged, not convicted yet.
- joe_the_user 8y ago"An even larger number of patients received unwanted braces sent to their homes. The unwanted products could disqualify them from receiving a brace under Medicare if they need one in the future, prosecutors said." So Medicare knows this happened and is still willing to disqualify random people from getting braces? Really? I mean, I believe it but still, this is where we are folks. It's like someone sued for "damaging" someone's credit, rather than just demanding that damaging information not being used. It's like an idiot going to jail for "SWATing" someone but where the SWAT team can still bust down doors and kill based on random tips.
- StreamBright 8y agoAnd people in the USA are ok with these. That is the most alarming thing for me.
- slapshot 8y ago> "The unwanted products could disqualify them from receiving a brace under Medicare if they need one in the future, prosecutors said." I read an implied "if we hadn't caught the fraudsters" into that sentence. As in "if we hadn't realized these braces were fraudulent, patients would have been denied braces they needed because they already reached the maximum number of annual braces covered by Medicare."
- bleriot 8y agoNot to mention that the government initially ignored a huge amount of complaints before finally investigating.
- r_smart 8y ago|It's like an idiot going to jail for "SWATing" someone but where the SWAT team can still bust down doors and kill based on random tips. Or getting the wrong house. Remember kids: Limited Immunity means complete immunity!
- deytempo 8y agoIf they get the wrong house, there’s always the possibility of them being shot and killed with no recourse. Any lawyer worth their weight in potato chips could get charges lifted from someone who guns down unidentifiable armed intruders entering their home unexpectedly.