Medicare
Continuing our discussion of psychiatric fraud (see our recent newsletter on Medicaid), we highly recommend an excellent article on Medicare and Medicaid fraud by Chris Parker in the St. Louis Riverfront Times (RFT) (“Thieves’ Bazaar: Hospitals, doctors and dealers have made Medicare the nation’s sweetest crime”, 4/25/2013).
Medicare is a federal government health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end-stage renal disease (permanent kidney failure requiring dialysis or a kidney transplant).
Following are some quotes and paraphrases from the RFT article.
“Think of the Medicare program as a bank that never bothered to buy a safe. Everyone from HMOs to drug dealers have been caught robbing it time and time again, stealing the kind of money that makes the sequester look like pocket change.”
Since 2007 the federal Health Care Fraud Prevention and Enforcement Action Team (HEAT)Â has charged 1,480 defendants with $4.8 billion in fraud.
In 2011 Mohammad Khan, administrator of Houston Riverside General Hospital, confessed to federal fraud investigators for enriching the hospital through a kickback scheme, paying “recruiters” $300 a head to bring Medicare patients to Riverside’s six psychiatric clinics.
“They arrived by the van-load for daily therapy sessions they rarely qualified for or received. Medicare picked up the $116 million tab.”
“Kahn ratted out CEO Earnest Gibson III as his co-conspirator. The feds also nabbed Gibson’s 35-year-old son, Earnest IV. He ran one of the psychiatric clinics and was charged with billing nearly $700,000 for care that ‘was not medically necessary and, in some cases, not provided,’ according to prosecutors.”
“Investigators discovered that, since 2005, the hospital had been swindling the feds to the tune of $22 million a year. Kahn pleaded guilty. The two Gibsons and five others await trial on charges of fraud, conspiracy and money laundering.”
Cuban expat Armando Gonzalez started several outpatient psychiatric clinics in Miami with a scheme similar to Riverside’s. “Gonzalez paid assisted-living facilities kickbacks to bus in residents suffering from retardation and dementia. The clinics would then bill Medicare for services the ‘patients’ weren’t eligible for or didn’t receive. By the time the feds started sniffing around in 2008, Gonzalez had already made off with $28 million…He closed shop in Miami, only to reopen in North Carolina. When he was finally arrested last year, Gonzalez was planning to expand into Tennessee.”
In 2010 Frank Walther of the Medicare fraud task force helped take down American Therapeutic, the highest-billing mental-health center in the country. “The company was cycling addicts, alcoholics and Alzheimer patients through its six clinics. Patients’ diagnoses were changed so they would qualify for expensive group therapy.”
In 2011 “Minnesota was pumping up its Medicaid reimbursements to cover losses in a state program that Medicaid doesn’t reach.”
Then there’s the Las Vegas Cocktail, mixing Xanax, Soma and Vicodin for a powerful opiate high. Michigan’s Monroe Pain Center, near the Toledo, Ohio, border, went from seeing 40 patients a day to as many as 250, prescribing 5 million doses of narcotics over two years, defrauding Medicare out of $5.7 million.
New York state centers for people with mental issues were charging the feds $5,000 per day per patient while Arizona only charges $200 a day. New York’s estimated overcharges: $15 billion.
Oh, my! Who’s paying for all this fraud? Medicare and Medicaid are government programs, financed by your tax dollars (and the federal debt.) Can anyone guess why health care costs are so high and continuing to rise?
What shall we do? What do you think? Has your own health insurance cost increased recently? Shall we just let this fraud continue?
These are not purely rhetorical questions. They do have some answers.
You are one of the answers. Contact your local, state and federal officials and representatives; let them know what you think about this situation. Suggest that they find out about all the money wasted on fraudulent and abusive psychiatric mental health care, and recommend that they reduce or eliminate the use of harmful, coercive and abusive psychiatric treatments and psychiatric drugs in favor of non-psychiatric alternatives, so that people with mental trauma can actually be helped rather than harmed.
Forward this newsletter to your family, friends and associates and tell them to subscribe.
More information about psychiatric fraud can be found by clicking here.
By the way, report Medicare fraud here.