Health Fraud

http://www.forbes.com/sites/aroy/2011/03/22/the-multimillion-dollar-medicaid-ambulette-scam/
QUOTE
Top 20 Largest Cases of Companies Caught For Committing Fraud - get source
Companies commit fraud against the US and State governments constantly. "The crooks know now that these computerized payment systems are their best friend,"

Medicare Fraud's Rick Scott:  When he was chief executive, the hospital chain committed among the largest Medicare and Medicaid fraud in history. ..For one thing he is a millionaire (some say billionaire) thanks to his health care companies. The healthcare industry has been good To Rick Scott.

Read more: http://news.injuryboard.com/medicare-frauds-rick-scott-leading-in-florida-gov-race-.aspx?googleid=282152#ixzz1VYcsJiT9

It is a great day in America when the government can combat corporate greed. Those people that are committing healthcare fraud must go to prison. ...

MORE FRAUD
Medicaid Ambulette Scam
“Ambulettes,” despite the cute name, aren’t actually little ambulances. They’re basically vans that pick up Medicaid patients from their homes and transport them to hospitals, nursing homes, clinics etc. Ambulettes can provide a useful and important service to, say, a disabled elderly woman who lives alone and has no other way to get urgently needed care.

So, you’d expect that major hospitals and health care facilities would be the largest users of ambulettes, right?

Wrong. According to the New York Post, which reviewed state records, the number one requester of Medicaid ambulettes in the state was Dr. Abraham Demoz, who runs a storefront clinic in Canarsie, in southeastern Brooklyn. Dr. Demoz ordered 110,894 ambulette rides in 2009, costing Medicaid $3.4 million. Demoz managed to far outdistance the No. 2 player, Beth Israel Medical Center, which ordered 76,159
trips for $2.5 million:

““The government gives [patients] the right to go anywhere authorized,” Demoz told The Post. “If they, say, go to the supermarket, guess what? I don’t know. I’m a doctor. . . . I’m just doing my job, and my job is to take care of patients.”

The feds recently raided the third-ranked ambulette chaser, another storefront clinic, accusing it of “colluding with ambulette provider Majestic Transportation, which took in $3.45 million from Mediciaid in 2009, to milk the system.” In total, New York State spends over $200 million a year on ambulette services: paying as much as three times normal cab fare, often for people who are perfectly capable of walking or taking public transportation.

These multimillion-dollar figures may not sound like much, when you consider that we spend $450 billion a year on Medicaid. But these are not isolated instances of fraud: indeed, they are symptomatic of a widespread problem that is estimated to cost taxpayers $45 billion annually. And that’s just Medicaid; the government estimates that Medicare is subject to an additional $60-100 billion a year in fraud.

But don’t worry—it’s all good.  We can solve all of Medicaid’s problems by spending more money.

UPDATE 1: I linked to it above, but just to be explicit, this 2005 exposé in the New York Times delves in great detail into the ambulette scam. Here’s one excerpt:

“With an immense public transit system and fleets of taxis and car services, New York is one of the nation’s easiest cities to get around in, even for the old and the sick. But instead of reimbursing patients for a $2 bus ride to their doctor’s office, or a $10 fare for a car service, Medicaid typically pays $25 or $31 each way for these rides, and it adds up.

New York Medicaid paid far more than any other state to get patients to hospitals and doctor’s appointments: $316 million in 2003. The state accounts for about 15 percent of all the nonemergency Medicaid transportation spending in the country, according to a 2001 report by the Community Transportation Association of America, and spends more than the next three states – California, New Jersey and Florida – combined.

The largest chunk of the $316 million spent on transportation went to some 450 ambulette services, about a fifth of which are clustered in Brooklyn.

And much of that spending appears to be entirely unnecessary.

That was clear on a recent afternoon in southern Brooklyn, when an elderly woman strolled out of a doctor’s office and clambered into the front seat of a van owned by M. J. Trans Corporation, a medical transport company that billed Medicaid for more than $2 million last year. After a 25-minute ride across the borough, she got out in front of her apartment, again without help, and walked inside.

The van is called an ambulette, and Medicaid is supposed to pay for it only when a patient cannot walk without help or requires a wheelchair. In fact, the state refers to the service as an “invalid coach.” But on three days spent following M. J. vans over several months, a Times reporter found that almost all of the company’s passengers walked easily, without assistance. The pattern was repeated as recently as last month.

UPDATE 2: Aaron Carroll takes issue with my snarky conclusion about spending more money. Here’s his main point:

“I (and other) members of the “spend more money brigade” don’t believe that the solution to all health policy problems is to spend more money. I believe the solution to the fraud problem is to invest in fraud prevention. I believe that the solution to the doctor under-reimbursement problem is to spend more money to pay doctors more. But there are lots of areas of Medicaid where we could spend less. But when someone wants to do that, it’s rationing and death panels.

Fair enough. Snarkiness tends to be unfair and oversimplifying, and I accept that criticism of my concluding sentence. I guess what I’m trying to say is, it’s disrespectful to taxpayers to not fully tackle the issue of fraud before dramatically expanding the program. We should, first and foremost, make an effort to spend wisely the money we have already allocated to Medicaid, before demanding that overburdened taxpayers fork over even more.

Secondly, Aaron’s suggestion that we increase our “investing in fraud prevention” sounds reasonable on the surface. But it’s not that simple. Government insurers are fundamentally unlike private insurers, who have an economic incentive to eliminate fraud. If you want to prevent fraud, you have to have a system in which the issuers of insurance have an economic incentive to prevent it. You can hire more detectives, but fraudsters are clever about hiding fraudulent billing amidst legitimate spending. The way Medicaid is legally structured makes it difficult to root out the problem.

UPDATE 3: I received a letter from a lawyer for Great Ambulette Service Inc., of Brooklyn, objecting to the use of an image from their web site. The letter states that the image “will result in immediate and irreparable harm to our client’s business reputation” and demands “a full retraction and apology” for doing so. I hereby apologize to Great Ambulette Service Inc. for using their image without their permission, and, as you can see, have taken down the image. However, I stand by the textual content of my article, and the facts and opinions contained therein.

http://www.forbes.com/sites/aroy/2011/03/22/the-multimillion-dollar-medicaid-ambulette-scam/
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Is the NHS de facto corruption? A lot of parasites make livings out of it. Some make very handsome livings. The boss is a communist; a very bad sign.