Medicare fraud – The Health Care Blog

Medicare Catheter Scam Sparks Calls for Reform

Jul 19, 2024

By ISSAC SMITH

According to a recent report in the Washington Post, a $3 billion scam involving urinary catheters has brought to light serious flaws in Medicare, prompting strong calls for reform. Apparently, several companies have been accused of gaming the system by submitting fraudulent bills for millions of catheters using patient and doctor information. This isn’t the first time Medicare has faced such challenges; fraudsters often target the system, especially in cases involving unnecessary medical equipment. With a budget nearing $1 trillion, the agency has faced significant challenges in tackling fraudulent claims for durable medical equipment. Leaders at CMS have appealed to Congress for more resources to strengthen their efforts against potential scammers.

Healthcare providers and lawmakers are now pushing for tougher measures to crack down on these companies and improve fraud prevention efforts. The National Association of Accountable Care Organizations (ACOs) has praised CMS for taking steps to address suspicious billing practices related to catheters, underscoring the importance of policy changes to protect against future abuses.

“This is unlike anything we have seen before in terms of its size and scope,” said Clif Gaus from the National Association of Accountable Care Organizations, which played a crucial role in uncovering and drawing attention to the alleged fraud.

Several accountable care organizations (groups of hospitals and doctors) said they could each lose more than $1 million if the fraudulent billing issue isn’t fixed.

In a proposed rule released on Friday, CMS stated that an investigation is currently underway, and that initial steps have been taken in response.

12 Common Medicare Scams

Dec 19, 2011• 5

By Richard Reece, MD

“To scam Medicare is not to give a damn for taxpayers. Money is money whether you earn it or steal it.”

– Anonymous

Christine Seivers of medicalbillingandcoding.org sent me the following list of common Medicare scams. I have edited and shortened her copy to fit my blog.

1. The Poser Scam

One common way to scam Medicare is to pose as a Medicare employee, a practitioner, or insurance representative. These fraudsters call, email, or send letters asking for personal information that includes bank, Social Security, and Medicare numbers.

2. The Healthcare Reform Scam

Healthcare reform is on the lips of everyone these days, and scammers are using it to cash in. Many adults don’t know what the new health care legislation actually entails. That’s just the way criminals want it. It makes many Americans easy targets for scams, like those that claim to sell “healthcare reform insurance” that purportedly protects seniors from any losses to their Medicare or any fines they make incur from not meeting guidelines.Continue reading…

The Untold Obama Administration Success Story

Aug 26, 2011• 14

By MERRILL GOOZNER

One wonders what the Obama administration has to do to get a little credit. I’m sitting on vacation, looking at the ocean most of the day, and spending about a half hour on line at night erasing unread emails, killing out unread RSS feeds, and checking up on my declining retirement prospects. Amid the clutter, a series of press releases from the Inspector General of the Health and Human Services Department caught my eye. Here are the headlines, with links (I’d link to the press coverage, but near as I can tell, there was none):

Miami-Area Doctor Pleads Guilty in $25 Million Health Care Fraud Scheme

Owner of Miami-Area Mental Health Care Corporation Convicted on All Counts for Orchestrating $205 Million Medicare Fraud Scheme

Miami-Area Medical Equipment Company Owners Sentenced to Prison for Medicare Fraud Scheme

That was Tuesday. On Monday, the HHS sleuths put out this press release:

FORMER CHAIR OF TEMPLE’S OPHTHALMOLOGY DEPARTMENT CONVICTED OF HEALTH CARE FRAUD

PHILADELPHIA – A federal jury today convicted Dr. Joseph J. Kubacki, 62, of Destin, Florida, of 150 counts of health care fraud, wire fraud, and making false statements in health care matters, announced United States Attorney Zane David Memeger. Kubacki was the Chairperson of the Ophthalmology Department of the Temple University School of Medicine and also served as the Assistant Dean for Medical Affairs when, between 2002 and 2007, he caused thousands of false claims to be submitted to health care benefit programs with false charges totaling more than $4.5 million for services rendered to patients whom Kubacki did not personally see or evaluate. A sentencing hearing has not yet been scheduled.