Is Medicaid, Medicare fraud real?
There may be a lot of media coverage on Medicaid, Medicare and the fraud involved in their services. It seems like every day we hear about healthcare scams involving illegal Medicaid and/or Medicare claims that were either paid or submitted for payment. However, Medicaid, Medicare fraud is more than media hype. It is quite a reality and costs taxpayers billions of dollars every year. In 2010 the Government Accountability Office (GAO) released a report identifying $48 billion in improper Medicaid, Medicare payments. This is not a new problem and even with task forces in place to strike against healthcare fraud, it still is a growing problem in our society.
In 2007 the U.S. Federal government developed a Medicare Fraud Strike Force. This force was put in effect to determine if businesses in Miami were involved in Medicare fraud. Of the 1600 randomly selected businesses it was determined that more than one third of them (481) didn’t even exist and yet they collected over $237 million dollars from Medicare for equipment charges. In 2010, it is documented that 94 healthcare providers were charged with $251 million dollars in phony Medicare and Medicaid claims, known as phantom payments. Medicare, Medicaid fraud is called an Open Invitation to Fraud and has become so lucrative now that the Russian and Nigerian mobs are involved.
In Florida Medicare fraud is more productive, less dangerous and because of this some New York crime families have relocated there. However, even with that Florida is not listed as one of the top states struggling with Medicare fraud. While every state has its share of Medicaid fraud, the Office of Inspector General lists the following states topping the list: California, Texas, New York, Ohio and Kentucky. In New York where Medicaid fraud has also been a big problem, officials suggest that 40% of Medicaid payments are questionable. For example, several years ago a Brooklyn dentist filed 991 false Medicaid claims in one day.
Nashville is affected as well with Medicare fraud. In 2009, according to the U.S. Attorney’s office, Glenesha Bowling Moye, Tabitha Jones, through their co-owned company, EBC Healthcare pleaded guilty to billing both Medicare and TennCare for services that were either never provided or provided by personnel who were not licensed to do so in the state. As a result, between 2005 and 2007, this couple racked up a total of $1.1 million dollars.
To sum things up we can safely state that on average tax payers lose approximately $100 billion dollars in waste, fraud and abuse in both Medicaid and Medicare programs yearly. The good news is that several states have recovered $1.7 billion in fraudulent payments in 2011. The bad news is that the government had to spend over $208 million in recovery efforts.
What can be done to help stop Medicaid, Medicare fraud?
The government is making every effort to stop Medicare, Medicaid fraud. But the government can’t do it alone. Are you are concerned and want to make a difference? If so there is something you can do about it. If you or anyone you know suspects Medicare or Medicaid fraud there are ways to report it 24 hours a day. Here are a few of the websites available to report Medicaid, Medicare fraud: The Tennessee Bureau of Investigation, the Office of Inspector General, and Medicare.gov. All of these sites are specifically designed and easily accessible for individuals to report Medicaid, Medicare fraud anonymously. The Center for Medicare and Medicaid Services has even provided an toll free number to report fraud: (800) 447-8477. There are also whistle-blowers’ laws to protect people who report Medicaid, Medicare fraud.
There is no reason now for anyone to sit down and do nothing! It is time for all of us to stand up, play a big part in cracking down on the Medicaid, Medicare fraud dilemma to help reduce the cost of healthcare in the United States.