Tuesday, October 18, 2011

Medicare Fraud Suspensions Not Enforced

Fierce Healthcare has;

October 17, 2011 — 1:25pm ET | By

Although federal agencies have been targeting provider companies in an effort to cease Medicare fraud, regulators oftentimes quickly reinstate licenses after having revoked them, according to an Associated Press (AP) article yesterday. Government employees and contractors frequently don't attend initial hearings when suspended companies appeal; the Centers for Medicare & Medicaid Services (CMS) declined to comment on why and whether it had to do with CMS staffing limits, according to the AP.
In addition, federal attorneys often don't attend the first round of appeals, according to the article.

"Nobody from (the government) bothers to attend the appeal hearing, so the judge hears a one-sided story and the government is virtually guaranteed to lose," said Ryan Stumphauzer, a former Miami federal prosecutor. "Every taxpayer should be outraged."

With limited governmental representation at appeal hearings, provider companies can win by default, according to the article.

Fraudsters bank on Medicare's "pay and chase" approach, in which criminals receive Medicare reimbursements and then run before regulators discover the fake claims.

"If Medicare wants to stop fraud, it can't keep pretending these are real providers," said attorney Kirk Ogrosky, former head of the Justice Department's division on healthcare fraud. "Medicare is adept at enforcing technicalities because the system has been designed for real providers, but outright crooks go undetected because their claims appear legitimate."

For more information:
- read the AP

Related Articles:
$205M Medicare fraudster gets longest sentence ever
Administration to target Medicaid fraud next
Feds unleash largest Medicare fraud takedown worth $295M
Feds cracking down on healthcare fraud, prosecutions to rise 85%

Thank You Fierce Healthcare and Ms Cheung, and by all means, Do, go read the AP article.

pg 2:

"Still, as the program has burgeoned to pay 4.4 million claims worth more than $1 billion per day"

At an estimated annual loss of even $90 Billion per year to criminal Fraudsters, that's 25 cents on Every $1.00 paid out. And you wonder How an entire Industry as patently, blatantly Fraudulent as 'Mental Health' manages to stay on its feet and keep feeding itself at everyone Else's expense.


Mark p.s.2 said...

"Nobody from (the government) bothers to attend the appeal hearing"

D Bunker said...

The true cost of trusting in the Idiocy of "We need a Program."

Government has become such a Behemoth that the people who Should be regulating and cleaning up problems like Big Pharma, just look the other way.

Why do you think Allen Jones got fired from the Penn OIG?

Mark p.s.2 said...

There is no one (with power) to keep the Government accountable.

D Bunker said...

And into Whose lap does this lack of enforcement fall?

"It could probably be shown by facts and figures that there is no distinctly native American criminal class except Congress.
- Pudd'nhead Wilson's New Calendar
Mark Twain

It's Not as if Congress can't Afford to get it right.

It's because the people in Congress can't Afford to step on the people who Bought them.