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Does Medicare fraud mean health professionals believe they are above the law?

Does Medicare fraud mean health professionals believe they are above the law?

Illustration to Help Stop Medicare Fraud.
Wikimedia Commons

Medicare fraud is no secret and healthcare providers are found guilty quite frequently for mismanagement of government funds. Some of this misconduct may not be intentional but when allegations lead to indictments it may be safe to conclude that there is little to question. And with all the publicity on convictions and prison time for mismanaging Medicare funds one can’t help but to wonder why are healthcare professionals still indulging in this fraudulent behavior? Could it be that they believe that they are not ever going to get caught? Are they so far gone with defrauding the government that they can’t stop their wrong doings? Could they actually believe they are above the law and can continue this ill-behavior indefinitely without ever paying a price? Well regardless of what the reasons may or may not be, the reality is that Medicare fraud is a serious crime with serious consequences.

Example of Medicare fraud in Atlanta, Georgia

In February 2014 a Dr. Lawrence Eppelbaum, a physician in Atlanta Georgia was sentenced to prison and fined $3.5 million dollars for defrauding Medicare and the IRS. He was convicted for 27 counts of healthcare fraud, tax fraud and money laundering. Dr. Eppelbaum who is licensed by the state of Georgia to practice medicine operated the Atlanta Institute of Medicine and Rehabilitation (AIMR) and the Pain Clinic of AIMR. The AIMR is a reputable healthcare organization in the Atlanta area and has helped many patients who experience chronic pain. In 2004 Dr. Eppelbaum created the "Back Pain Fund" through the AIMR. He had total control over the "Back Pain Fund", directly and indirectly. From 2004-2009 Eppelbaum received more than $16 million dollars from Medicare for the care he provided to his patients. Unfortunately he mismanaged these government funds and evaded paying the IRS more the than a million dollars that he owed through his organization. Now Eppelbaum has to pay the price for his misconduct as a physician in the healthcare profession.

There are many more examples of healthcare fraud in Georgia committed by healthcare professionals. I have listed the above example because of the depth of this physician's convictions and the consequences he suffered. I also used this illustration to point out that when someone has total control over any funding organization, the environment becomes an ideal place for fraud and/or embezzlement to take place.

In summary

Medicare fraud is a reality in the United States. In May of 2014, the Medicare Fraud Strike Force published a report, charging 90 individuals (27 medical professionals, including 16 physicians) for false Medicare billing in the amount of $260 million dollars. So even though it appears to be a lot of media-hype about healthcare fraud, there is also a lot of real-life situations taking place among healthcare professionals and lay people.

Sadly, every time Medicare fraud takes place, funds are taken away from the future of caring for our senior population. This is bad news but there is also good news. We all can play a significant part in putting a halt to Medicare fraud because we now have the power. So if you or anyone you know is aware of any Medicare fraudulent acts and want to make a difference, please visit the Stop Medicare Fraud website and/or the Medicare Fraud Reporting Center and let your voice be heard. Remember, what affects one eventually affects another. Believe it or not, we are all in this together! So let us all stand tall and strong against Medicare fraud and make the difference!

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