A Charlotte woman has pleaded guilty to defrauding Medicaid through her company, in order to purchase an expensive Mercedes Benz automobile.
U.S. Attorney Anne Tompkins announced Wednesday that 43-year-old Joye Strong faces a maximum of 10 years in prison and fines of up to $250,000 per count. Strong faces eight counts altogether in this case.
In 2009, Strong fraudulently billed Medicaid for services her company, Advocating for America never performed. Bilking Medicare in excess of $83 thousand dollars (See: Charlotte woman pleads guilty to Medicaid fraud http://www.wral.com/news/state/story/10225962/)..
Joye Strong it seems, is just another example of someone taking advantage of the Medicare system. She is not alone in this however.
How big is the problem of Medicare fraud? I'm so glad you asked.
It has been estimated that a full 20 % of every dollar that is spent on Medicare goes to fraud.
Medicare fraud is a mega huge problem that costs taxpayers more than $80 billion dollars every year, according to the Congressional Record. That is an unbelievable amount, when you consider that the entire budget for Medicare is $468 billion dollars.
On May 6, 2009, Daniel Levinson, the Inspector General of the Department of Health and Human Services, testified before the Senate Special Committee on aging that: "it is not possible to measure precisely the extent of fraud in Medicare and Medicaid." This is freaking unbelievable, when you think about it!
Medicare fraud is so huge, that the people who actually administer the program themselves cannot really tell you exactly how big the problem is.
Some of the general ways people and organizations rip Medicare off are:
1) Falsifying documents to increase Medicare payments
2) Receiving kickbacks for the referral of Medicare patients for home health care services.
3) Submitting medical services reimbursement claims for procedures that were never done to Medicare, Medicaid
4) Submitting fraudulent reimbursement claims for prescription medications that were never actually dispensed.
5) Submitting claims for chiropractic services that were never rendered.
6) Falsely represented results of tests that had not been reviewed by board-certified specialists as required.
In all these cases, it is important to remember that the people ripping off Medicare were doctors, owners of home health care services companies, pharmacists, owners of pharmacies, licensed chiropractors, medical services companies...
I think there is an assumption that doctors, healthcare professionals, pharmacists, hospital administrators, and nurses are NOT the ones ripping Medicare off - when in fact they are the people doing it in many cases. I tell people that sometimes and they are shocked!
Case in point - in one of the largest healthcare fraud cases, the U.S. government charged 114 doctors, nurses and other defendants with Medicare crime schemes that exceeded $225 million in false billings (see article: "Largest Medicare fraud case nets 114 offenders" http://www.news-medical.net/news/20110220/Largest-Medicare-fraud-case-nets-114-offenders.aspx).
These were the latest of a series of cases that were announced by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius. In fact, critics warned that the 45 million elderly and disabled Americans who are enrolled in taxpayer-funded Medicare plans are subject to this fraud. It happens all the time...
In one of the largest Medicare fraud case in U.S. history, law enforcement agents have charged 111 people in nine cities with filing millions of dollars in bogus claims see article: "Record-breaking Medicare fraud case includes 10 arrests in Tampa area" (http://www.tampabay.com/news/publicsafety/crime/record-breaking-medicare-fraud-case-includes-10-arrests-in-tampa-area/1152219.)
In yet another case two people were accused of "conspiracy" to commit a massive fraud against Medicare for $200 million dollars. See article: "Couple pleads guilty in massive Medicare fraud case" http://www.miamiherald.com/2011/04/13/2167010/couple-to-plead-guilty-in-major.html
I could go one citing case and case, but you get the idea. The important thing to remember is that it is just not doctors and hospitals "ripping Medicare off" for millions. Its people and organization you might not suspect. Its cities and local governments doing it as well. As shaocking as that may sound.
In one case, Dallas-Fire Rescue officials and the city’s longtime ambulance service billing vendor knowingly collected fraudulent overpayments from Medicare and Medicaid http://firelink.monster.com/news/articles/14096-tx-fire-officials-billing-service-accused-of-fraud.
The story just scratched the surface of the real problem. There are literally thousands of cities, as represented by fire departments and ambulances services also doing the same thing to Medicare, but nobody will investigate it. It is a type billing code fraud called “up coding” and it happens all the time.
In another case a federal lawsuit filed by a former Clinton firefighter and paramedic alleges that the Clinton Fire Department claimed some medical call cases were more serious than they really were in order to receive increased reimbursement payments from the Medicare and Medicaid programs (http://qctimes.com/news/local/article_5c335f5a-ad74-11de-a3e5-001cc4c002e0.html). These are city workers and employees. They were also "ripping off" Medicare? Who would have believed it? City officials, firemen and paramedics committing fraud?
The Medicare system is ripe with fraud like this.
Organized crime has also infiltrated the Medicare system, and feed on the edges of it, like parasites.
Unless major reform happens, fraud in Medicare will never stop.
Sadly, Congress has already indicated an unwillingness to do anything to stop fraud in Medicare.
After all, who cares - someone else pays for it, right? Wrong! In all these cases, it is you the taxpayer who are is paying for it!
Often times you read articles advising people specifically Medicare patients to be careful, not give out their numbers, watch their billing statements, and report cases of fraud to Medicare.
They tell you things like to "Guard your Medicare and Social Security numbers". Treat them as you would treat your credit cards.
Medicare, on their website, also gives people advice in the matter like:
• Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. We will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
• Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It is illegal, and it is not worth it!
• Do not let anyone borrow or pay you to use your Medicare ID card or your identity.
• Check your Medicare claims for errors. Look at your Medicare Summary Notice (MSN) or statements from your Medicare plan.
The onerous is on you the Medicare patients to watch out for fraud and prevent it - as if you are the problem.
The real problem is people like Joye Strong and others who take advantage of the system. But it is also health care professionals, hospitals, city governments and for profit insurance companies. Then the question is how do your protect yourself from them as a Medicare patient? The short answer is you can't!
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