Medicare Criminals And Their Enablers

      After reading The Herald’s stories about the rampant Medicare fraud in South Florida, Miami psychiatrist Dr. Mario S. Cuervo wrote me to suggest that the problem has as much to do with the program’s shoddy administration as the criminals who cheat the system out of millions. Mind you, this is his opinion, not necessarily mine. And it may be colored by his own personal frustrations dealing with Medicare’s infamous bureaucracy. But he says it with such wonderful fervor:

“Having read the latest blitz of articles in our local newspaper about the abundance of  “Medicare fraud” in South Florida, two things come to mind:

1) What company would allow their CEO to report another billion dollar loss year after year?

2) Provider numbers are obtained by these criminals who are defrauding medicare. Do you know who is responsible of approving these provider numbers?

3) How is it that the fraud in South Florida stops like a miracle when patients join an HMO?

 Answers:

1) There isn’t a company that would keep the same CEO who fails to control losing money to fraud, except the US government. First things first -- start by firing people who don’t do their job. And unfortunately Medicare is full of them, and you can start from the top down (CMS), then move down to Regional in Atlanta and work yourself down to all the worthless people who work for Medicare in Tallahassee who are incapable of answering a simple question correctly if any provider needs one answered.

They should be ashamed having to inform every week that another fraud had been committed and $100 million were paid by Medicare to criminals. Criminals always look for easy targets and, boy, Medicare  is one.

2) Medicare Provider numbers should only be given after a person who is applying is fully investigated and for the first couple of years should also be monitored closely for any irregularities instead of waiting until $100 million disappear.

3) The reason you don’t see fraud in an HMO as you see it in Medicare is because an HMO is a private institution that must report to owners, who make their workers and bosses responsible. Fraud , though possible, is unacceptable. If a mistake is made it has to be fixed or “heads will roll.” I am a physician and do not promote HMOs as the cure (far from it), but I point this out because HMOs  have taken control of this problem and the government has not. Maybe is time they learn.

The only way Medicare knows how to deal with the losses they are having from fraud is by trying to cut down payments to physicians and hospitals until they can no longer sustain a private practice, not losing money to Medicare because of under payments or lack of payments. This problem is leading to an exodus of physicians from Medicare and will reflect on quality of health care in this country in the near future. And Medicare will still be telling us how some criminal stole another $100 million dollars from them.

Comments

[Walter Ward]

I agree with the ideaof getting rid of the dead wood starting at the top down but who will start it. Why can't large government corporations use retired folks to do some of the checking. I would volunteer as a retiree. Do a real time study of the government offices.

[George]

Mr. Obama, are you listening? If only you could be so intelligent in implementing this "change." We need a real CEO in your seat.

[sylvia lambourg]

Why must a person be a US Citizen to work for the federal government? Yet, anyone can get a provider number to bill medicare shouldn't those individuals also be US citizens? I believe they should after all when you are a provider in essence you are also working for the Federal Government. This get rick quick scheme has to stop!

[carlos reyes]

I agree with Dr Mario Cuervo 100%. The problem with Medicare fraud are not "the crooks", the "benitezes" (who stole 100 million), the few doctors who lack sense by doing stupid things such as fraud, the patients that take 50-100 dollars monthly to keep the aerosol machine, the fraudulent companies that bill for services that were not rendered; the main problem is THE MEDICARE SYSTEM, and obviously the group of INEPTS that works there. If Medicare were to have a tight system, we would not have this massive fraud!

[Ana Sol Alliegro]

Fraud in Medicare and Medicaid may be substantially mitigated taking the following steps:

1. As a prerequisite to issuing the provider number that allows a medical facility to bill Medicare/Madicaid, CMS and/or AHCA, should conduct a proper due diligence investigation of medical directors and owners to include the identification of personalities, associates, source of business start-up capital.
2. Require a surety bond for a minimum of $1 million.
3. Place a new facility on a pre-payment edit for at least 6 month.
4. Making it a criminal offence for a medical director NOT to immediately report when the affiliation with a medical provider is terminated.
5. Prohibiting electronic fund transfers for payment go to a branch of a foreign bank.
6. Licensing so-called billing consultant and coding companies and holding them to the same standards as the owners of the medical facilities.
7. Terminate any government employees if they fail to comply with or circumvent regulations when licensing a medical facility. If collusion is indicated, as in the case of phantom clinics, the government inspector should be investigated to the fullest.