Thread: Protecting your pocket book HEALTH CARE FRAUD

http://www.fbi.gov/page2/july07/health_care072007.htm

A billion here, a billion there, and pretty soon you're talking real money," the late Senator Everett Dirksen is supposed to have said.*

And so it is today with health care fraud, a burgeoning crime plague that's adding up in a big way, big-ticket scheme after big-ticket scheme, essentially costing you money every time you walk into a hospital or doctor's office or fill a prescription, whether you know it or not. The National Health Care Anti-Fraud Association estimates that this fraud collectively costs Americans between $60 billion and $100 billion a year. Ouch.

Our role in combating the problem? We're the primary investigative agency, with jurisdiction over federal programs like Medicare and Medicaid (both big targets) and private insurance programs, all the while working hand-in-hand with plenty of public and private sector partners. Locally, our agents team up with their investigative counterparts on health care fraud working groups, task forces, and strike teams to tackle the biggest scams. Nationally, we have a Health Care Fraud unit at FBI Headquarters that helps support and coordinate field investigations and leads field-wide initiatives.

An anniversary, of sorts. It was 15 years ago, actually, that we ran our first major health care fraud investigation—"Operation Gold Pill." It involved about a thousand "professional patients" getting prescriptions for medicine they didn't need and having them filled at pharmacies that billed Medicare for much more than the cost. The patients then sold the medication at a discount to dealers, who turned around and hawked it on the street or repackaged it and sold it back to the pharmacies—a full circle of crime.

Fifteen years ago this month, as the investigation came to a head, hundreds of FBI agents and other law enforcement professionals fanned out across the nation, making more than a 100 arrests and seizing more than $30 million in cash and assets. By today's standards, that's pocket change. But soon, more resources came our way, and we were in the business of busting healthcare fraud full-time.

A million ways.... Today, the schemes are more complex, more time-consuming, and more costly than ever. "There's literally millions of ways to defraud health care," our Associate Deputy Director Joseph L. Ford told reporters this week. "They come up with new ways every day." Just a very few examples of what we see:

Hospitals, doctors, pharmacists, and other care providers submitting fake bills for services never rendered—or overcharge;

Service providers charging insurance for unnecessary and costly procedures;

Doctors selling prescriptions to patients for cash;
Companies billing insurance for expensive equipment but providing poor substitutes;

Crooked docs enticing patients to visit their offices for "free services" or gifts, then stealing their personal information and using it to file fake claims.

Your role. As with any white-collar fraud, we depend on alert and conscientious citizens for help. We encourage you to contact us if you come across any suspected abuse—either on the job or in your own personal lives. Please do yourself a favor and keep an eye on your explanation of benefits to make sure you're not getting billed for services or items you never received. And please safeguard your insurance card—and your patient information—just like you would a credit card. It's fodder for identity thieves, as well.

For more telling details on health care fraud, see our recent Financial Crime Report. And visit our Be Crime Smart webpage to arm yourselves with more facts about the latest scams and frauds.

* - The Dirksen Congressional Center questions whether he ever said this or anything similar; see its website for details. But it's such a good quote!

http://www.fbi.gov/contactus.htm

Hospitals, doctors, pharmacists, and other care providers submitting fake bills for services never rendered—or overcharge

I left a job for that very reason. They wanted me to put down therapy on a patients chart that I didn't do. I refused. They wanted me to add x-ray fees for a series instead of just the 1 shot they actually took. This was for medicare and I wouldn't do it. They told me it was done all the time. It was their way to re-coup their other losses and besides......it wasn't comming out of the patients pocket. There was a dual billing system.......and their eyes lit up like saucers when it was a good insurance company. Easy money. They learn the tricks to keep things out of the radar.........I couldn't do it. I knew payback would come for those abuses......but they were just thinking of the here and now. Wasn't long after that they started cutting things and HMO's started telling them what they could and couldn't do.

When I had my girls I took a birthing class and they told us what things to bring to the hospital in order to cut down on expenses. I was charged for things I never used because someone opened the sealed packages before I ever got in my room......guess they got wise to the trick.....and once that seal is broken.....it's yours.

I also know they bombarded my dad with bills after my mothers death and after he got home.......definately not in a good state of mind or with the ability to make sense of all those papers. They were double billing him and it took his attorney to keep on the slick tricks. If it weren't for him.......lord only knows how much more they would have milked out of him. Daddy was raised with pay your bills and he'd rather die than owe a penny to anyone.

Don't even get me going on the price of meds. It's a shame you can't get your money back when something doesn't work or you're allergic to it instead of having to toss the money away. I have a terrible time with tolerating meds and finally my pharmacist suggested to just get a dose or 2 till I knew if I could take them after he saw the tons of money I was wasting on things I couldn't take. If he didn't tell me.....I never knew you had that option.

I'm dreading this next week. I need inhalers refilled. No problems....no side effects......but I'm gonna end up dumping close to a hundred to go to a nurse...get weighed, blood pressure taken and a new script. I'll wait a couple hours and probably the whole visit will last 5 minutes.....but....that's the law.....so you do it. Atleast she speaks English........that's not common around here.