Medicare Fraud Is A Crime That Should Concern Everyone

Health care is one of the biggest concerns that Americans worry about. Another big concern is the economy and the federal deficit. How are both of these concerns related? Well, it has been reported that if waste and fraud in the health care system were eliminated, it would be enough to pay for health care reform.

Medicare fraud is estimated to total around $60 billion a year. That would make it one of the most profitible United States crimes. Medicare is a government health insurance program that was set up to provide health care for Americans that are disabled or elderly. Currently 46 million Americans benefit from Medicare, but so do the criminals, through Medicare fraud.

How serious and prevelant is Medicare fraud? It has been reported that Medicare fraud has replaced cocaine as the primary criminal business in South Florida. Some individuals have claimed they stole more than $20 million dollars from Medicare before being discovered.

There are several ways that Medicare fraud occurs. A report by 60 Minutes said there were thousands of small pharmacies and clinics that are located in the low-rent strip malls. They reported that no one was inside the clinics, no patients, employees, and no doctors. One small medical supply company billed Medicare about $2 million in one month, and they never found anyone there.

There are even situations where there aren't even any physical offices at a location that is sending bills to Medicare. The FBI, IRS, and Health and Human Services have set up task forces to try and deal with the problem of Medicare fraud.

Unfortunately, Medicare fraud is big business... a big criminal business. Criminals that commit Medicare fraud have been known to involve doctors, get patient lists, recruit patients, and devise scams to take money from the Medicare program. Stealing from the American taxpayers.

Medicare fraud is a nationwide problem and isn't just confined to any part of the country. In Detroit, over 50 people were arrested and charged for billing Medicare more than $50 million dollars for procedures that weren't medically necessary.

On the west coast, in Los Angeles, the City of Angels Medical Center actually brought homeless people into the center to fill the empty beds. They provide the homeless with food and money, and billed Medicare millions of dollars for their stay.

The really disturbing aspect of Medicare fraud is how easy it is for the criminals to steal from Medicare. Criminals acquire lists of Medicare patients through theft and buying patient lists stolen from hospitals and doctors. All they need to bill Medicare for a patient are names, addresses, date of birth, and Social Security numbers.

Once they have these lists, they submit phony invoices to Medicare for payment, and the Medicare agency is required to pay the claims within 30 days. Medicare does have auditors that check to make sure that claims that are filed are valid, but the volume of legitimate and false claims is simply overwhelming.

The best defense against Medicare fraud are the beneficiaries of Medicare. The Medicare patients get quarterly statements that list the items and care that Medicare has paid. If you check your statements and there are items or services that you haven't received, you should contact Medicare immediately to report the situation.

Medicare seems to be concerned about the situation, but really don't have enough field staff available to deal with the current situation. When a criminal intent on Meciare fraud can set up a phony company, have a fake store front, obtain a list of Mediare patients, file millions in false claims to Medicare, get paid within 30 days, shut down, and move to a new location, it is like trying to capture a fast moving target.

Fortunately, the new adminstration has committed to reducing Medicare fraud and waste. The Obama administration provided Medicare with $200 million additional dollars to fight Medicare fraud as part of the stimulus plan. The computerization of medical records and updating computer networks should help Medicare identify and capture those criminals involved with Medicare fraud.

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The official U.S. Government Medicare Web site is Medicare.gov.