Why is there no "war on fraud"?

[RickN]

Fraud is one of the biggest parts of government waste and if they really crack down on it, the government agencies would not need so much money, and they can not have that.

Seriously the fraud that is caught is estimated by most sources to be 10% or less of the ongoing fraud.

And yes the healthcare industry has just as many crooks as even lawyers. The only real difference is we admit it and do not pretend we can police ourselves.

 

[Billybob]

Seriously the fraud that is caught is estimated by most sources to be 10% or less of the ongoing fraud.

I hadn't heard that but did wonder how much goes undiscovered. So if the $3 Billion in FY 2010 FCA Cases is around 10% were talking big bucks, maybe enough to really change some things in this country.

 

[copertop80]

Because we'd be arresting too many policitans and lawyers if there were

 

[sherrick13]

Because the pols benefit from it.

 

[Billybob]

Another example...

http://www.justice.gov/opa/pr/2011/June/11-crm-871.html

Department of Justice

Office of Public Affairs

FOR IMMEDIATE RELEASE

Thursday, June 30, 2011

Miami-Area Psychiatrist Pleads Guilty for Role in $200 Million Medicare Fraud Scheme



WASHINGTON - A Miami-area psychiatrist pleaded guilty today in U.S. District Court in Miami for his part in a fraud scheme that resulted in the submission of more than $200 million in fraudulent claims to Medicare, the Department of Justice, FBI and Department of Health and Human Services (HHS) announced.



Dr. Alan Gumer, 64, of Tamarac, Fla., pleaded guilty to one count of conspiracy to commit health care fraud. Gumer was charged on Feb. 15, 2011, with one count of conspiracy to commit health care fraud and four counts of health care fraud.



According to court documents, Gumer was a psychiatrist at American Therapeutic Corporation (ATC), a Florida corporation headquartered in Miami. ATC purported to operate partial hospitalization programs (PHPs) in seven different locations throughout South Florida and Orlando. A PHP is a form of intensive treatment for severe mental illness.

Gumer admitted that he signed evaluations, notes and other documents in medical files for patients who did not need the treatment for which ATC billed Medicare. Specifically, as a psychiatrist, Gumer knew that the patients attending ATC did not need intensive mental health treatment, and that the treatments offered by ATC were not the type of intensive treatments a PHP should provide. Gumer admitted that he signed these files without examining the patients, or writing and reading the statements he was signing. Gumer also admitted to writing prescriptions for psychiatric medications for patients who did not need them in order to make it appear to Medicare that the patients qualified for PHP treatment. According to court documents, Gumer also referred hundreds of ATC patients to a related company, the American Sleep Institute (ASI), for unnecessary diagnostic sleep disorder testing.

According to court filings, Gumer’s co-defendants and ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities (ALFs) and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and ASI. In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC and ASI conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and ASI could bill Medicare for more than $200 million in medically unnecessary services.

According to the plea agreement, Gumer’s participation in the fraud resulted in $19.3 million in fraudulent billing to the Medicare program. Sentencing for Gumer is scheduled for Jan 19, 2012. Gumer faces a maximum of 10 years in prison and a $250,000 fine.

ATC, its management company Medlink Professional Management Group Inc., and the owners and lead manager of ATC, Medlink and ASI, were charged with various health care fraud, money laundering and other offenses in a separate superseding indictment unsealed on Feb. 15, 2011. Two of the three owners and the lead manager, as well as both ATC and Medlink, have pleaded guilty and have admitted to the fraudulent scheme and that more than $200 million in billings were submitted to the Medicare program as a part of the scheme. They are scheduled for sentencing on Sept. 14, 2011, by U.S. District Court Judge James Lawrence King. The trial of the third owner charged in the separate superseding indictment is scheduled to begin on Aug. 15, 2011.

The remaining 17 co-defendants named in the indictment in which Gumer was charged are scheduled to stand trial on Nov. 7, 2011, before U.S. District Judge Patricia A. Seitz.

An indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami field office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The criminal case is being prosecuted by Trial Attorney Jennifer L. Saulino of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants that collectively have billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov

 

[Jestoni]

The pharmaceutical sector is often lauded for medical advances, making narcotics that save lives. However, it is equally lambasted for dodgy tactics such as Medicare and Medicaid scam, which large pharmaceutical corporations are perpetrating to the tune of billions of dollars per year. http://www.newsytype.com/14892-pharmaceutical-medicare-fraud/

Health is wealth! Since lots of people are concerned to their health so I guess some took advantage to this fact to scammed others.

 

[mightymouse]

Because only Congress has the constitutional authority to declare war, and frauds cannot declare war on themselves without looking like, well, frauds.

 

[twoguns?]

Because only Congress has the constitutional authority to declare war, and frauds cannot declare war on themselves without looking like, well, frauds.

LOL that makes me think that ...the war on drugs..is led by people comitting fraud..
I also noticed that the fines were a lot less than the amount defrauded...?

 

[Hobbes]

Richard Lynn "Rick" Scott is a businessman and the 45th and current Governor of the U.S. state of Florida.

He was forced to resign as Chief Executive of Columbia/HCA in 1997 amid a scandal over the company's business and Medicare billing practices; the company ultimately admitted to fourteen felonies and agreed to pay the federal government over $600 million.

On March 19, 1997, investigators from the FBI, the Internal Revenue Service and the Department of Health and Human Services served search warrants at Columbia/HCA facilities in El Paso and on dozens of doctors with suspected ties to the company.[20]

Following the raids, the Columbia/HCA board of directors forced Scott to resign as Chairman and CEO.[21] He was paid $9.88 million in a settlement. He also left owning 10 million shares of stock worth over $350 million.[22][23][24]

In 1999, Columbia/HCA changed its name back to HCA, Inc.

In settlements reached in 2000 and 2002, Columbia/HCA pled guilty to 14 felonies and agreed to a $600+ million fine in the largest fraud settlement in US history. Columbia/HCA admitted systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about use of hospital space. They also admitted fraudulently billing Medicare and other health programs by inflating the seriousness of diagnoses and to giving doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA. They filed false cost reports, fraudulently billing Medicare for home health care workers, and paid kickbacks in the sale of home health agencies and to doctors to refer patients. In addition, they gave doctors "loans" never intending to be repaid, free rent, free office furniture, and free drugs from hospital pharmacies.[4][5][6][7][8]

In late 2002, HCA agreed to pay the U.S. government $631 million, plus interest, and pay $17.5 million to state Medicaid agencies, in addition to $250 million paid up to that point to resolve outstanding Medicare expense claims.[25] In all, civil law suits cost HCA more than $2 billion to settle, by far the largest fraud settlement in US history.

 

[doctorjj]

There is an ongoing war against it. Look at TrailBlazer and all of the other firms that CMS has hired to crack down on payments and they ways in which they try to deny claims.