Government

Low administrative costs don’t get you much … unless you are out to defraud 🤑

Here is what “low administrative costs” and a claim policy that is pay and pursue get you. $1 billion in fraud not caught for fourteen years. If Medicare followed procedures common with private insurance companies, this would be very unlikely. 

Patients and doctors hate pre-authorization and medical necessity scrutiny and it can be annoying, but this case is just one of way too many examples of what happens when you have a loose claim policy. Government oversight groups have been pointing this out for years and yet little has been done. 

The New York Times

7-22-16

U.S. Says Florida Network Defrauded Medicare and Medicaid of Over $1 Billion

By ERIC LICHTBLAU

JULY 22, 2016

WASHINGTON — In the largest case of health care fraud ever brought by the Justice Department, federal prosecutors on Friday charged three people at a network of Florida nursing and assisted-living facilities for their suspected role in a scheme to defraud Medicare and Medicaid of more than $1 billion.

Prosecutors charged that Philip Esformes, 47, of Miami, who owns 30 nursing homes and assisted-living facilities in the area, created a fraudulent network built on billing Medicare for performing lucrative procedures that were not needed.

Over a period of 14 years, Mr. Esformes’s facilities would take in Medicare and Medicaid recipients who did not actually qualify for skilled nursing or assisted-living facilities, then bill the government programs for their care, prosecutors charged.

Advertisements

Categories: Government, Healthcare, Medicare

Tagged as:

1 reply »

What's your opinion on this post? Readers would like your point of view.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s