Help STOP Blatant Medicare fraud. Every taxpayer dollar counts.
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Blatant Medicare, Medicaid, insurance fraud in running rampant in the healthcare industry.
Specifically, acceptable widespread healthcare fraud which plagues our nation- costing taxpayers billions (possibly quadrillions)each year.
The following threats face our nation:
• Abolishment of the Affordable Care Act • Social Security Trust Fund Depletion. Every dollar counts!
As a Certified Professional Coder (AAPC), Certified Professional Medical Auditor (AAPC), and CA Licensed Real Estate Broker(CABRE), but more importantly I’m a law abiding citizen concerned about a legislative issue that needs to be addresses (immediately).
Yet healthcare providers and facilities, both knowingly and unknowingly, are defrauding Medicare, Medicaid, and other commercial insurance payers. Even though the guidelines to prevent fraud and definitions are clearly outlined in several laws including the Affordable Care Act (“ACA), False Claims Act (“FCA”), Frank Dodd Act and the Office of Inspector General (“OIG”).
But less than 20% of alleged fraud cases are pursued. Over 80% of alleged fraud cases are flying under the radar, costing the government and taxpayers hundreds of millions (if not billions) of dollars.
The consensus is that: “Medicare isn’t going to conduct an audit if reported”
“Allowing violations of basic insurance principles will lead to demise of insurance industry”-Senator Collins [CSPAN Individual Health Insurance Market hearing Sept 6, 2017]
Case and Point:
A company that I worked for routinely misstated facts to for several services including but not limited to, complete stress echocardiograms, critical care services, cardiac monitoring and billing undocumented services. Complete stress echocardiogram, with documentation supporting “limited echocardiogram results in a $14.00 overpayment per claim. No, it doesn’t sound like much. But let’s look at the totality of what it means to Medicare, Medical, Commercial Insurance Payers and taxpayers.
There were over 82,000 billings for stress echocardiogram(s) during a 9-month period, over 9,111 stress echocardiograms billed per month. The margin between complete stress echo vs limited stress echo was (-$14.00). If 50% of facts of complete stress echocardiograms billed were intentionally misstated, the sum of these recklessness would cost taxpayers nearly $800,000 per year. Coupled with three (3) times overpayment, and $21,563 fine per claim for intentionally misstating facts to obtain undeserved payment as required per Federal False Claims Act, results in over $1 Billion Dollar missed opportunity per year.
MISSED REVENUE OPPORTUNITY-OVER A BILLION DOLLARS ($1,185,236,532)
[This narrative illustrates loss revenue of over $1 BILLION dollars for one service in which facts were intentionally misrepresented for $14.00 financial gain, that OIG routinely fails to pursue- because the dollar amounts doesn't appear large enough, or they simply do not have the resources. Instead, the OIG would rather perform routine audits instead of allocating those resources in pursuit where known violations exist. In this scenario, $1B loss to Medicare only depicts one fraudulent service bill. However, Stanfords University Healthcare Alliance fraudulently billed at least four (4) services in reckless disregard for the truth.
Actual losses nationwide= QUADRILLIONS
Unless something changes this will continue. There is no real deterrent for this gross negligence that plagues the healthcare industry. It’s easy to see it’s a bigger problem of fraud being reported, but the 80% alleged cases being neglected.
One of the biggest healthcare entities in the San Francisco Bay Area have willfully employed “schemes” to defraud Medicare, Medicaid, and other commercial payers. Issuing directives that includes but is not limited to intentionally unbundling procedure codes to obtain undeserved revenue or fraudulently gained revenue.
This flagrant disregard and will negligence of proper policies and procedures set forth by the Office of Inspector General (“OIG”) has become a cancer that threatens the future of healthcare and our society as a whole.
“…Is it morally or ethically right to take money from the taxpayer and give it to the insurance company...” –Senator Rand Paul [CSPAN Individual Health Insurance Market Hearing Sept 6, 2017]
Even worse, interpretation of Federal Law has not been standardized.
Case and Point:
EEOC (Equal Employment Opportunity Commission) and DFEH (Department of Fair Employment and Housing) both agree written warning is the first step of progressive discipline; however in the 9th District Federal Court Judge ruled written warning is not an adverse employment action.
This discretionary interpretation of the law, that Congress has worked hard to create undermines the intelligence of the False Claims Act (Lincoln Law) itself. Such attitudes will also lead to the demise of the integrity of our constitution in which our country was founded.
Whats worse, because the OIG dismisses over 80% of fraud claims reported, there isn't any retribution for employers retaliating against its employees.
Let's Demand Congress allocate resources towards recovery efforts of those funds. Please sign your name below.
Thank you in advance for your time and attention to this matter.
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