Undercover Grandma Catches Medicare Fraud on Tape

[cbayer]

Shameful.

http://abcnews.go.com/Blotter/undercover-82-year-grandma-catches-medicare-fraud-tape/story?id=15818462#.T1AAj8zhMz0

By MEGAN CHUCHMACH (@megcourtney) and BRIAN ROSS (@brianross)
March 1, 2012

In the wake of an ABC News undercover investigation, federal authorities in Texas are investigating how an active 82-year-old grandmother was diagnosed as homebound, with a range of ailments that she did not have, including Type 2 diabetes, opening the door to potentially tens of thousands of dollars in Medicare payments for home health care, supplies and equipment she did not need.

A hidden camera recorded the undercover grandmother's visit to a doctor in McAllen, Texas, where she told the doctor and nurses she exercised regularly and, other than some hypertension and arthritis, was in excellent health.

"I've really enjoyed good health all my life, God's been good to me," the doctor was told by Doris Ace, the grandmother of ABC News producer Megan Chuchmach.

Yet the official certification sent to Medicare for home health care services indicate she was homebound and suffered from two internal infections, incontinence and needs "assistance in all activities, unable to safely leave home, severe sob," an abbreviation for shortness of breath.

more at link

[rfranklin]

1. Medicare probably wouldn't have any problems for years if they would bust the crooks...

but no, that would be too logical.

$375M health care fraud scheme went unnoticed for years; some critics say system broken

DALLAS — The Texas doctor accused of “selling his signature” to process almost $375 million in false Medicare and Medicaid claims went unnoticed for half a decade by a fraud detection system that some critics say is broken.

Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy’s Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn’t begin until about a year ago, officials said.

http://www.washingtonpost.com/business/industries/texas-medical-group-owner-among-7-indicted-in-alleged-375-million-health-care-fraud-scheme/2012/02/29/gIQAzfMchR_story.html?tid=pm_business_pop

[cbayer]

2. Medicare has a long history of just paying the bill.

While most providers are honest, imo, it has been a system amazingly easy to bilk.

I think the Obama administration has put some significant resources into fraud and abuse detection and can claim some victories, but there is so much more to be found.

[pinboy3niner]

3. Maybe they need more undercover grannies

A TV series would be a great recruiting tool...

Law & Order: Undercover Granny

[cbayer]

4. Actually, that's a great idea.

I know my 82 year old mother would do it in a heartbeat.

[ellisonz]

5. Medicare fraud is rampant.

We should be taking a hard look at ways to increase anti-fraud enforcement.