Robert Stein 1924-2014

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Sunday, October 07, 2007

Health Care Crime

Of all the ills of American health care, least visible is the pervasive fraud it encourages in everyone involved--doctors, patients, labs, hospitals and, most of all, the insurers who manage the mess.

One small symptom can be seen today in a New York Times report of 91 Medicare audits showing “widespread violations of patients’ rights and consumer protection standards” in private drug plans for the elderly that were supposed to save them money but, in some cases, are endangering their lives.

Slap-on-the-wrist fines totaling $770,000 on 11 companies won’t make a dent in the billions they are raking in from the most vulnerable Americans, who might have been helped by authorizing Medicare to bargain with pharmaceutical companies or allowing medications to be imported from Canada instead of devising new ways for insurance companies to fleece them.

Other clues about the enormity of health care fraud emerged this summer when the new Justice Department Medicare Fraud Strike Force announced measures to crack down on medical companies that send phony bills or provide excessive treatments, pointing to 2,400 investigations last year and warning that more cases were on the way.

The FBI, which estimates health-care stealing to total between $60 and $100 billion dollars a year, lists a few of the ways it’s done:

Hospitals, doctors, pharmacists, and other care providers submit fake bills for services never rendered--or overcharge for those delivered.

Service providers bill insurance for unnecessary and costly procedures.

Doctors sell prescriptions to patients for cash.

Companies charge insurance for expensive equipment but provide poor substitutes.

Crooked M.D.s entice patients to visit their offices for "free services" or gifts, then steal their personal information and use it to file fake claims.

If you have a strong stomach, you can Google “health care fraud” and get 23 million hits, many reporting convictions of providers across the country. But reading too many may make you sick and in need of medical attention.

1 comment:

Dr. Stimplove said...

Honestly, it's ridiculous that you folks in the U S of A don't have single-payer universal health care by now. Instead, you stick with the "simplicity" of HMOs, insurance companies and out-of-control drug companies and their lobbyists.
Oh, and the magic of the marketplace which leaves nearly 50 million uninsured and (as Sicko showed us) many millions more with health insurance that won't come through for them when they need it.
Helluva system you got there.