Part 6. They Have More Ways To Steal Than You Can Dream Of!
Paul Jesilow, Department of Criminology at the University of California and Bryan Burton, Department of Political Science and Criminal Justice at Southern Utah University specify that:
“Healthcare fraud involves wide-ranging illegal behaviors. It includes such activities as individual physicians who bill insurance companies or the government for services that were never provided, as well as corporate behavior, such as pharmaceutical companies that falsify clinical tests in order to get unsafe drugs approved for use. Thousands die each year in the United States due to these behaviors, including deaths from incorrectly prescribed medications or from tainted drugs that were approved by the U.S. Food and Drug Administration based upon fraudulent testing and reporting. Thousands of additional patients likely are injured and killed by unnecessary surgeries performed by physicians who want to maximize their reimbursements. The illegal activities also add billions of dollars each year to the total healthcare cost in the U.S. Despite these costs, there is relatively little outrage as a result of the behaviors, largely because they remain hidden from public view.”
One of the greatest scams in Canadian history involved Ontario and Alberta paying hundreds of millions of dollars to American hospital chains to treat people for addiction. The hospitals had hired “bounty hunters” who picked up people off the street in Canada to send to these facilities. The “patients” were promised a vacation at taxpayer expense and when they got to the U.S., their “treatment” often consisted of barbeques with hamburgers and hot dogs. They returned in whatever condition they left, and the government paid $150,000 for each of them. And although it was widely exposed in the media, the government did everything in its power to squash the issue. The money was never recovered from the American hospital chain.
In California, there was a case of a hospital that billed Medicare for more than nine years and with more than 150 beds that earned millions of dollars in fees. There was only one problem: the hospital had never been built.
Then there were all the Ontario cases for supposed patients being treated for addiction by Methadone. The patients billed for were street people. Their identities had been procured and were being used to bill taxpayers, but it was nothing but a scam as hundreds, if not thousands, of them did not even reside in the facilities that were doing the scamming. Not to mention that none were ever recorded as cured.
In April 2016 it was exposed in the National Post, headline reading “Methadone doctor accused of coercing patients into using pharmacy linked to his clinic: Patients said the Brantford doctor threatened to cut off their take-home doses and physically walked them into the store, according to a disciplinary ruling.”
Then there are:
- Billing for “phantom patients”
- Billing for fabricated conditions
- Billing for medical goods or services that were not provided
- Billing for more hours than there are in a day
- Paying or receiving a “kickback” in exchange for a referral for medical goods or services
- Concealing ownership in a related company
- Using false credentials
- Double-billing for healthcare goods or services not provided
- Billing for a non-covered service as though it were a covered service
- Misrepresenting the provider of the service
- Dispensing a lower-cost drug and billing for the higher-cost one
- False or unnecessary issuance of prescription drugs
- Billing for drugs never dispensed
- Unnecessary surgery and other procedures
- And several hundred more
How is it even possible that this magnitude of fraud can occur? Is it difficult or even impossible to detect? Emphatically, no. Keep reading – we cover that in part 7 of our series.