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The Federal law is unconstitutional. Pass a Constitutional amendment or let it go.

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Same reason 2nd Amendment infringements and a lot of other stuff haven't.

It's really too bad the Founders didn't grant most of the power to the States,and the people,and only gave the federal government limited powers.................

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My wife's former boss was arrested in this mess on Wednesday.  (Wife had no idea about the fraud).  Nice enough guy, I had to ask myself if there was a card for this event, something along the lines of "Sorry to hear about your federal felony indictment."

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The Federal law is unconstitutional. Pass a Constitutional amendment or let it go.

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That's up to SCOTUS, not gd or armchair justices.

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Dog and pony show.

They nabbed 412 suspects in what is possibly the most fraud ridden industry in America, and now they parade themselves around and want pats on the back.

That's some mighty fine police work.

Maybe next month they can wrangle up a few frauds using their welfare monies to buy drugs. Think it's doable?

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Yep,5 people in black robes found it Constitutional for the federal government to force us to buy something.

All hail SCOTUS.

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Putting aside the question of the federal government even having the Constitutional authority to go after drugs,how about PRIORITIES???

I'm sure there are literally countless federal laws NOT being enforced at this time,but why not go after the big fish-hillary,holder,comey,lerner,etc....?

It's like a cop going after a jaywalker,while ignoring rape,murder,burglary,and rape.

I'm pretty sure I'm not the only one that wanted to see this administration go after all the lying scum that inhabit the swamp right from the start.

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I'd like to hear more of this.

Curious if he was defrauding,or it's just one of the cases NavyDoc referenced.


O/T-There's an old man here in town that used to run a small Mom and Pop bakery with his wife.She did the books.

They lived very frugally and didn't have much.They get audited one year,and apparently she had been making a mistake from the start.Lost everything,and his wages were garnished for years.

Meanwhile,Sharpton owes millions,Rangel and Geithner were allowed to pay their back no problem,and hillary.......

It's almost as if there are 2 sets of laws in this country..............

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Short version is that they provided mental health service with a medicaid contract,  if they provide service A, they charge X amount of money, if the provide the service  B, they changed Y (more amount of money).  They did service A but charged more money for service B.  That and they had a conspiracy kickback  scheme with another service provider,  that service provider would refer clients to former boss, then get a 10% kickback in violation of federal anti kickback laws.   They are fucked.

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No, he's not.

ETA:  and you'd do well to NOT call out a Life Member, who happens to be a physician, and knows a thing-or-two about Medicare billing.

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Yep,5 people in black robes found it Constitutional for the federal government to force us to buy something.

All hail SCOTUS.

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No, he's not.

ETA:  and you'd do well to NOT call out a Life Member, who happens to be a physician, and knows a thing-or-two about Medicare billing.

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How do you know there isn't anybody "going after" the big fish?

If you could solve 500 crimes and save the taxpayers 4.5 trillion dollars with X amount of political capital, that's not worth doing it if that political capital could save taxpayers zero dollars (or cost 5 billion for the prosecution) and solve 15 crimes by the same cunt?

Sorry, your logic is "i didn't get my way, going to whine about it".

We're all hoping hillary gets thrown in jail before she dies, but banking everything on that and doing NOTHING ELSE is fucking stupid.

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I don't "know" if anyone is going after the big fish.

I'm just going by years of experience watching this shit play out.

Somewhere in DC,right this minute,top men are building a case against holder,hillary,comey,etc..............

Many of us wanted/expected Trump to go after the criminals at the top of our government.The more time that goes by,the less likely it is to ever happen.

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That's up to SCOTUS, not gd or armchair justices.

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Please point out how I'm wrong.

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Let me make my point crystal clear since I seem to have been quoted at least 12x in this thread.

I am glad some one is doing something.

But let's be honest here. Insurance and medicaid/medicare fraud has to be more than a few hundred billion a year.

Just because you nabbed the low hanging fruit estimated at 1.2 (or whatever) billion doesn't mean jack shit to me.

Keep up the pressure and get 25% or even 40% cleaned up and I will be giving my praise. Not .5%

A very common politician tactic.  

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I thought we didn't like Sessions?

Maybe he's good at doing his job--- ENFORCING THE DAMN LAW--- and we've forgotten what that looks like?

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You've failed to point out where I'm wrong. All you have is "weight of majority decision", which is in no way necessarily correct. My stance isn't opinion. It's fact. The war on drugs is unconstitutional. No where within the constitution is the U.S. government given the power to tell people what they can or can't put into their own bodies. The role of government isn't to protect dopers from themselves.

 10A NCAC 22F .0606 TECHNIQUE FOR PROJECTING MEDICAID OVERPAYMENTS

(a) The Medicaid agency will seek restitution of overpayments made to providers by the Medicaid program.

(b) The agency may use a Disproportionate Stratified Random Sampling Technique in establishing provider overpayments.

(c) This technique is an extrapolation of a statistical sampling of claims used to determine the total overpayment for recoupment.  

     Disproportionate Stratified Random Sampling Technique.

What????

“Disproportionate” is defined as, “being out of proportion.”

“Stratified” is defined as, “the process of dividing members of the population into homogeneous subgroups before sampling. The strata should be mutually exclusive: every element in the population must be assigned to only one stratum. The strata should also be collectively exhaustive: no population element can be excluded.”

“Random” is defined as, “having no specific pattern, purpose, or objective.”

The definition of “Stratified Random Sampling” is, “a method of sampling that involves the division of a population into smaller groups known as strata. In stratified random sampling, the strata are formed based on members’ shared attributes or characteristics. A random sample from each stratum is taken in a number proportional to the stratum’s size when compared to the population. These subsets of the strata are then pooled to form a random sample.”

I had a tough time, as a double-major in English and Poli-Sci, with the whole “stratified” definition until I spoke, at length, with a statistician expert.  According to (we will call him Bill) Bill, two of the most important factors in a Disproportionate Stratified Random Sampling Technique are randomness and strata being mutually exclusive.  Meaning, each date of service (DOS) and each Medicaid recipient must be independent of one another, i.e. if Medicaid recipient X on DOS 1/1/10 is found to be incorrectly found noncompliant, then no other recipient and no other DOS should be contingent on finding of noncompliance from recipient X, DOS 1/1/10.  (As I explained to Bill, I had heard of strata before…plural for a layer of sedimentary rock or soil…but, apparently, this was a different strata).

Here’s a more specific and concrete example:

PCG audited 100 claims of my client, Samantha, the Medicaid provider.  Of the 100 claims, PCG audited 5 DOS for Medicaid recipient A: 2/3/10, 2/17/10, 3/1/10, 3/12/10, and 3/19/10.  The reason that PCG cited all 5 claims as noncompliant was that the auditor found no consent for services by the recipient.  In actuality, there was a consent for services.  The Medicaid recipient was only 10, so his mother signed the consent.  Problem? Mother’s last name was different from child’s last name? So PCG did not know that the signator was the mother. (Really, I say? Really?? In 2013? FYI: My last name is different from my daughter’s last name. But no private insurance has ever questioned the connection between my daughter and me).  Anyway, once the issue with the consent was cleared up (by explaining the child’s mother signed the consent), all 5 DOS were found compliant.          

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RAC audits explained.




http://www.enttoday.org/article/audit-agony-prepare-yourself-as-insurers-look-to-recoup-funds/



NC Medicaid Extrapolation Audits: How Does $100 Become $100,000?

   Unfortunately, even the mere allegation of fraud leads to prepayment review. This, in turn, can harm even the most innocent provider. Last year in New Mexico, fifteen behavioral health care providers were put on prepayment review based on “credible allegations of fraud.” Because their Medicaid reimbursements were suspended, the providers could not afford to pay their staff, rent, or other bills. The providers tried suing the state and sought an injunction that would restore funding. The providers argued that they had been denied due process by not being told what the precise charges were against them, and that at the end of the day those suffering the most were their patients. However, they were denied the injunction.
As a result, the fifteen providers ended up filing for bankruptcy. Because the behavioral health care providers served 87% of New Mexico’s Medicaid recipients, the state of New Mexico had to bring in providers from Arizona to service residents. This caused state infighting, as New Mexico’s Legislative Finance Committee objected to the New Mexico Human Services Department moving $10 million from its budget to pay Arizona agencies to take over New Mexico providers.      

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Something similar happened to a guy running an auto repair shop some years ago (My Dad knew the guy).

Guy got caught taking cash and not collecting sales tax (NY).Not sure how he got caught.

Anyway,they figured he did that once a work day for so many years and it totaled up to a shit ton of money.Put him out of business,and I don't know what happened to the guy.

If they actively defrauded the gov (taxpayers),then fine,but I can't help wonder how much is just a witch hunt on the little people that don't have the resources to fight back.

Government at all levels has the ability to really screw you over.