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Around the country, a never-ending stream of Medicare and Medicaid rip-off stories suggest many people now use these programs as personal tills. In July 2010, authorities exposed and shut down a more organized scheme, charging 94 conspirators from five cities who had stolen $251 million from Medicare.
Three months later, in October 2010, 52 members of an Armenian American organized-crime ring were arrested and charged with $163 million in fraudulent billing.
Scores of reports over the last decade catalog completely implausible Medicare and Medicaid claims paid, apparently without a hiccup, for patients who were dead, imprisoned or previously deported from the country and forbidden to return. A significant number of claims involved prescribing physicians who were long-since dead.
Just a drop in the bucket, right dback, analjelly, TTBF, MensaSF? I mean, it's a small price to pay, right? Oh, but it gets better....we're HELPING them steal:
What makes these healthcare programs so vulnerable to fake billings and at such a scale? It's not so much the healthcare policy itself, nor the program design; the vulnerability stems from the payment mechanism the government has chosen to use. Most Medicare and Medicaid funds are paid out electronically and automatically, in response to electronic claims received from a vast spectrum of providers. Most claims are adjudicated by computers using rule-based systems, with no human intervention at all.
Fraud perpetrators have only to learn the rules; then they can submit thousands of claims electronically and with relative impunity. If they get things wrong, they'll receive helpful computer-generated messages explaining their mistake. Those committing fraud find it easy to get paid for fabricated claims because the government's systems check for billing correctness but not for truthfulness. The simple rule for getting rich quick through healthcare fraud is "bill your lies correctly."
And lest ye think it's just Medicare using sytems like this, read on:
This problem is not restricted to healthcare. Federal and state agencies increasingly disburse funds through such "electronic signal in, electronic payment out" (ESI-EPO for short) systems. The economic stimulus package, for example, included 56 tax provisions projected to cost $288 billion. Ten of these have already been designated high risk because of the likelihood of fraud made easier with electronic processing. Submit a qualifying tax return electronically, and if it has been completed correctly, out will come an electronic payment with no human intervention and little or no validation of the supporting evidence.
Payments for the stimulus fund's first-time home-buyer credit were found to have included $9 million to 1,300 prisoners, 241 of whom were serving life sentences when they purportedly bought homes. More than 10,000 taxpayers received credits for homes also claimed by other taxpayers, and one home was claimed by 67 claimants. The home-buyer program paid out more than $23 billion in total, and claims sampled after the fact showed dead people and young children showing up as "home buyers," in patterns eerily reminiscent of healthcare fraud.
The US Gov't has left the country's wallet on the street with a big flashing neon sign pointing to the wallet saying "FREE MONEY HERE!!!", and crooks are helping themselves to as much as they can carry. There's no accountability, no concern, and no real effective method for closing the gaps and loopholes. This country is absolutely FUCKED if they think our government should run/handle ANY more of our money.
Focus on the true criminals, dumbfuck.
