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Posted: 7/14/2017 8:55:26 AM EST
[#1]
Quote HistoryQuoted:
It shouldn't be "fraud" when there is a simple coding error- Everyone can probably agree on that. By the same token, they SHOULD care about accuracy and not overpay due to errors, and unfortunately, there is a line somewhere where "simple coding errors" do become actual fraud. In programs as large as the Medicare/Medicaid programs are, there is a significant amount of actual fraud and much of it goes undiscovered. One way to discourage others from thinking about committing fraud is essentially to make Draconian examples of those who mess up. "Kill one, terrorize a thousand"....In a program that large, it's about their only hope of compliance. Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. |
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Posted: 7/14/2017 8:58:33 AM EST
[#2]
Quote HistoryQuoted:
The entire medical industry engaged in fraud, racketeering, price fixing, and monopolistic pricing. Wake me up when they start prosecuting all of that. Anti-trust laws are violated by all of them. Not to mention that current medical pricing is subsidizing the people without insurance, those that don't pay, medication costs to Europe, etc. That's why you see $200 things of abd pads on bills. Because Juan Valdez with no insurance, or Shaquanisha, or Billy Bob don't pay, don't have coverage, etc, so their bills get rolled into everyone else's to keep the lights on. Doesn't help that the .gov takes 4-12 months to pay as well. So while you are right on the price fixing, the massive chunk of that blame lies on the shoulders of good ol' Uncle Sugar.  Can't charge less than what they'd accept for a service after all.
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Posted: 7/14/2017 9:00:23 AM EST
[#3]
Quote HistoryQuoted:
"But but but Sessions hates my marijuana." " Worst appointment by Trump." "Too old school Bible thumping Republican." "Fuck Sessions" That's the GD opinion of him so this must not be a good thing. "But.... muh chronic......." |
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Posted: 7/14/2017 9:00:43 AM EST
[#4]
Quote HistoryQuoted:
1.3 billion. Wow! What percentage of the 13.6 trillion dollar debt is that? |
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Posted: 7/14/2017 9:01:21 AM EST
[#5]
Quote HistoryQuoted:
Reads like 'pissed into ocean, caused coastal flooding'. Financially it'll provide the same boom as Joe Blow finding $0.25 on street. In reality, if politicians see 1.6 billion saved - they'll spend 10.6 billion. Want to color me impressed? Get some of the American trillions looted by the banks and con-gressmen. While it's a lot to one man, a billion ain't shit when it took a $999 million in man hours to get it and we're still 20 trillion in debt. |
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Posted: 7/14/2017 9:06:07 AM EST
[#6]
Quote HistoryQuoted:
1.3 billion. Wow! What percentage of the 13.6 trillion dollar debt is that? |
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Posted: 7/14/2017 9:10:33 AM EST
[#7]
Quote HistoryQuoted:
Huh... just read in another thread that sessions was the worst.  
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Posted: 7/14/2017 9:11:04 AM EST
[#8]
Quote HistoryQuoted:
Slight problem with your logic. 8+ year investigation. So unless Trump is lending out his time machine, it's not exactly a Sessions thing. Just landed in his lap. A billion + in fraud is still a nice penny though. |
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Posted: 7/14/2017 9:11:54 AM EST
[#9]
Quote HistoryQuoted:
You'd make a great politician... Quote HistoryQuoted:
Quoted:
1.3 billion. Wow! What percentage of the 13.6 trillion dollar debt is that? |
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Posted: 7/14/2017 9:12:53 AM EST
[#10]
Quote HistoryQuoted:
You're not exactly wrong, but dismissing the billion as being trivial is the same attitude politicians have and IS exactly why the country is in the shitter... |
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Posted: 7/14/2017 9:33:35 AM EST
[#11]
Quote HistoryQuoted:
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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Posted: 7/14/2017 9:37:47 AM EST
[#12]
Quote HistoryQuoted:
The entire medical industry engaged in fraud, racketeering, price fixing, and monopolistic pricing. Wake me up when they start prosecuting all of that. Anti-trust laws are violated by all of them. |
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Posted: 7/14/2017 9:42:32 AM EST
[#13]
He should arrest congress for theft
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Posted: 7/14/2017 9:54:52 AM EST
[#14]
Quote HistoryQuoted:
The government shouldn't be doing draconian things that destroy people just to make a point. The Eighth Amendment to the United States Constitution states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. |
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Posted: 7/14/2017 10:13:15 AM EST
[#15]
Quote HistoryQuoted:
Bingo! Actually most haven't forgotten, they just don't want them enforced and would be happier with the Obama and Holder administration. |
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Posted: 7/14/2017 10:24:52 AM EST
[#16]
Quote HistoryQuoted:
He should arrest congress for theft Start at the top. "While today is a historic day, the Department's work is not finished. In fact, it is just beginning. We will continue to find, arrest, prosecute, convict, and incarcerate fraudsters and drug dealers wherever they are. We will use every tool we have to stop criminals from exploiting vulnerable people and stealing our hard-earned tax dollars. We are continuing to work hard to develop even more techniques to identify and prosecute wrongdoers. We are sending a clear message to criminals across the country: we will find you. We will bring you to justice. And, you will pay a very high price for what you have done." Seems that would apply to holder,hillary,most of the House and Sen ate,etc.......
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Posted: 7/14/2017 10:29:02 AM EST
[#17]
Meh, to me it's not about the money, it's all about the prosecutions and examples being made. As far as I am concerned they can use the money to build space to keep the fraud-meisters in.
Drops in the bucket you ignorant peeps say......Those drops fill the bucket by and by.
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Posted: 7/14/2017 10:31:49 AM EST
[#18]
Fucking epic. This is what winning looks like.
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Posted: 7/14/2017 10:33:36 AM EST
[#19]
Yet hilliary walks free. And Comey. And the rest of them. No Obamacare repeal, not tax plan.
When I had my first 2 knee arthroscopies I had plenty of pain management. When my knee was replaced I practically had to beg for the bare minimum. I don't know where these people find doctors to give them something for pain. The ones around here just let you suffer, they are too afraid to prescribe it. So I have no fucks to give about sessions and his personal vendetta. |
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Posted: 7/14/2017 10:34:16 AM EST
[#20]
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Posted: 7/14/2017 10:35:49 AM EST
[#21]
Quote HistoryQuoted:
Even a dumbass can occasionally get something correct. Dude seriously needs to drop the pot needle thing. It's not helping. Quote HistoryQuoted:
Quoted:
Huh... just read in another thread that sessions was the worst. Dude seriously needs to drop the pot needle thing. It's not helping. |
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Posted: 7/14/2017 10:37:21 AM EST
[#22]
Quote HistoryQuoted:
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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Posted: 7/14/2017 10:38:57 AM EST
[#23]
Quote HistoryQuoted:
Meh, to me it's not about the money, it's all about the prosecutions and examples being made. As far as I am concerned they can use the money to build space to keep the fraud-meisters in. Drops in the bucket you ignorant peeps say......Those drops fill the bucket by and by. Kind of like the IRS fucking over the little people,while the big guys go free. This is a good start if legit and not just for show,but I still want to see hillary,holder,comey,etc...take freaking center stage for all their shit. 
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Posted: 7/14/2017 10:45:10 AM EST
[#24]
Quote HistoryQuoted:
The government shouldn't be doing draconian things that destroy people just to make a point. The Eighth Amendment to the United States Constitution states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. Now, whether or not the fines are too high etc...I can't say, not my area of expertise but I think they should sting- whatever level that means in the applicable case.... I certainly think there should be a way to fix or appeal honest mistakes because given a certain volume of work, in any field, there are going to be honest fuck ups, everyone is human, it happens. |
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Posted: 7/14/2017 10:53:32 AM EST
[#25]
Quote HistoryQuoted:
I thought we liked "free market" solutions vs. more government agencies and mandates and expense? Isn't that what a private contractor is, a free market solution? I think that's much better than government agencies that end up being essentially bought off or rendered ineffective by Lobbyists and their paid politicians on behalf of the "regulated"........ I don't have a problem incentivizing them to root out fraud and corruption, seems like a reasonable way to handle the problem. Now, whether or not the fines are too high etc...I can't say, not my area of expertise but I think they should sting- whatever level that means in the applicable case.... I certainly think there should be a way to fix or appeal honest mistakes because given a certain volume of work, in any field, there are going to be honest fuck ups, everyone is human, it happens. |
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Posted: 7/14/2017 10:57:41 AM EST
[#26]
Quote HistoryQuoted:
Reads like 'pissed into ocean, caused coastal flooding'. Financially it'll provide the same boom as Joe Blow finding $0.25 on street. In reality, if politicians see 1.6 billion saved - they'll spend 10.6 billion. Want to color me impressed? Get some of the American trillions looted by the banks and con-gressmen. While it's a lot to one man, a billion ain't shit when it took a $999 million in man hours to get it and we're still 20 trillion in debt. either way this is a START and most importantly it signals an attitude change with regards to dealing with waste fraud and abuse.... yea...its a DROP.....but every flood starts with a DROP..... |
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Posted: 7/14/2017 10:58:57 AM EST
[#27]
Quote HistoryQuoted:
Please, folks... read the good doctor's above post before you start cheering on Medicare "fraud" investigations. It's not a good system. Quote HistoryQuoted:
Quoted:
The government shouldn't be doing draconian things that destroy people just to make a point. The Eighth Amendment to the United States Constitution states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. 
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Posted: 7/14/2017 11:00:45 AM EST
[#28]
Quote HistoryQuoted:
But it's not a free market solution. It is giving a private company the monopoly of extortion power over citizens with the power of the federal government behind it with he ability to make civil and criminal prosecutions. I rather like that they are incentivized to find the fraud vs. being threatened by a bought off Congressman with a loss of their budget etc... because the Lobbyists paid him off. Government agencies are captured all the time (the Fiasco that is the FDA and their role in the spread of Meth due to Big Pharma lobbying is a great example of this) medicine has the potential to be the worst for that given the amount of money involved. |
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Posted: 7/14/2017 11:04:28 AM EST
[#29]
Quote HistoryQuoted:
1.3 billion. Wow! What percentage of the 13.6 trillion dollar debt is that? |
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Posted: 7/14/2017 11:05:05 AM EST
[#30]
Quote HistoryQuoted:
The government shouldn't be doing draconian things that destroy people just to make a point. The Eighth Amendment to the United States Constitution states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. |
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Posted: 7/14/2017 11:08:30 AM EST
[#31]
Quote HistoryQuoted:
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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Posted: 7/14/2017 11:18:29 AM EST
[#32]
Quote HistoryQuoted:
First you have to get the government out of guaranteeing their monopolies. Can't open or expand a hospital in Georgia without a certificate of need, which will likely be denied if there is another facility in the area with that capability. Hard to have competition to lower prices when competitors aren't allowed to build facilities. Quote HistoryQuoted:
Quoted:
The entire medical industry engaged in fraud, racketeering, price fixing, and monopolistic pricing. Wake me up when they start prosecuting all of that. Anti-trust laws are violated by all of them. Same as with ISP providers, only it's even worse in the medical field. |
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Posted: 7/14/2017 11:23:00 AM EST
[#33]
Quote HistoryQuoted:
I just wonder who is being made an example of.Is it actual fraudsters,or is it bullshit stuff like NavyDoc pointed out? Kind of like the IRS fucking over the little people,while the big guys go free. This is a good start if legit and not just for show,but I still want to see hillary,holder,comey,etc...take freaking center stage for all their shit. IMHO if that somewhere is the low-hanging fruit then that's just fine by me.
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Posted: 7/14/2017 11:40:37 AM EST
[#34]
Quote HistoryQuoted:
NavyDoc is full of shit, use your common sense and if you do your common sense should dictate that you have to start somewhere. IMHO if that somewhere is the low-hanging fruit then that's just fine by me. 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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Posted: 7/14/2017 11:42:40 AM EST
[#35]
Quote HistoryQuoted:
No, he's not. Quote HistoryQuoted:
Quoted:
NavyDoc is full of shit, use your common sense and if you do your common sense should dictate that you have to start somewhere. IMHO if that somewhere is the low-hanging fruit then that's just fine by me. 
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Posted: 7/14/2017 11:43:58 AM EST
[#36]
Quote HistoryQuoted:
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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Posted: 7/14/2017 11:46:44 AM EST
[#37]
Quote HistoryQuoted:
Because money always equals credibility. *click* |
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Posted: 7/14/2017 11:49:11 AM EST
[#38]
Quote HistoryQuoted:
and most of the crybabies that say 1.3B is nothing will turn around a say 1.6B to get the border wall rolling is a King's ransom. either way this is a START and most importantly it signals an attitude change with regards to dealing with waste fraud and abuse.... yea...its a DROP.....but every flood starts with a DROP..... Like 100 illegal immigrants self-deporting because they read the news story about one who is picked up and sent home, no? Also if the implementation of FedGov's fraud investigations is as NavyDoc stated, then I can see why doctors are refusing to take on medicare patients. |
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Posted: 7/14/2017 11:51:17 AM EST
[#39]
Quote HistoryQuoted:
Like 100 illegal immigrants self-deporting because they read the news story about one who is picked up and sent home, no? Also if the implementation of FedGov's fraud investigations is as NavyDoc stated, then I can see why doctors are refusing to take on medicare patients. 
Don't get me wrong, Medicaid, Medicare, VA, Native Affairs, etc need audited like crazy, BUT having someone with the incentive of screwing you as deep and hard as possible for any infraction is not the way to go about it. I can't blame docs for declining those pt's in that case. |
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Posted: 7/14/2017 11:54:02 AM EST
[#40]
Quote HistoryQuoted:
*yawn* *click* |
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Posted: 7/14/2017 12:00:19 PM EST
[#41]
Quote HistoryQuoted:
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? Good shit gets done and all you do is piss, moan, and groan... |
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Posted: 7/14/2017 12:02:53 PM EST
[#42]
Quote HistoryQuoted:
More than Obama did, or (at least that I remember) Bush. Former investigator told me that unless the fraud is hundreds of millions, the US Attorney's office will not take the case. |
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Posted: 7/14/2017 12:05:25 PM EST
[#43]
Here is a link that explains the extrapolation that NavyDoc (that guy who is so "full of sh*t") was talking about.
I'll excerpt briefly: The CMS contractor will send a provider/supplier a letter requesting money due based on a statistical sampling of an overpayment estimation or extrapolation. The initial post payment review letter will inform the provider/supplier that this is an extrapolation. The demand letters are tied to multiple claims and will typically include large dollar amounts.
Two Types of Overpayments Identified - One claim (or single claim) for one supplier/provider Extrapolation - Sample of claims used to estimate dollars paid in error for a universe of similar claims for a specific period of time The demand and/or post payment review letter will identify the type of overpayment. |
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Posted: 7/14/2017 12:11:01 PM EST
[#44]
Quote HistoryQuoted:
Even a dumbass can occasionally get something correct. Dude seriously needs to drop the pot needle thing. It's not helping. |
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Posted: 7/14/2017 12:22:38 PM EST
[#45]
Quote HistoryQuoted:
Here is a link that explains the extrapolation that NavyDoc (that guy who is so "full of sh*t") was talking about. I'll excerpt briefly: |
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Posted: 7/14/2017 12:25:24 PM EST
[#46]
MAGA.
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Posted: 7/14/2017 12:32:47 PM EST
[#47]
Quote HistoryQuoted:
Please, folks... read the good doctor's above post before you start cheering on Medicare "fraud" investigations. It's not a good system. Quote HistoryQuoted:
Quoted:
The government shouldn't be doing draconian things that destroy people just to make a point. The Eighth Amendment to the United States Constitution states: “Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” Certainly there is fraud and it should be punished, however, the way the do it now is downright evil. You're not going to be "investigated for fraud" by law enforcement agents. Medicare (thanks to Obama) contracts out your "investigation" to a private for profit company who is paid by a percentage of how much they can squeeze out of you. They come in, audit your charts and look for the tiniest of coding errors. Let's say they sample 100 charts. Let's say that they fine ONE coding error. That's "fraud" and they take the money back from you and give you a $10,000 dollar fine on top of that. Then, they figure out how many medicare patient visits your practice sees in a year, going back 5 years. Let's say your practice has about a 1000 medicare visits in a year (not that large, a 5 doc practice could easily reach those numbers). So that's 5000 medicare visits the last 5 years. The extrapolate your one case of "fraud" to a "fraudulent billing rate" of 1% and then determine that with a 1% fraud rate, you MUST have fraudulently billed 1% of those 5000 visits in the last 5 years for an extrapolated 50 counts of fraud that carry a 10,000 dollar fine each. They slap a $500,000 fine on the doctor, ruining him. Good people have killed themselves after such a fiasco. |
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Posted: 7/14/2017 12:42:30 PM EST
[#48]
Quote HistoryQuoted:
Federal law says marijuana is illegal. He's doing his job. Sounds like a snowflake issue when you say a law enforcement officer shouldn't do his job because it unduly effects your ability to break the law. |
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Posted: 7/14/2017 12:48:18 PM EST
[#49]
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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Posted: 7/14/2017 12:50:49 PM EST
[#50]
Quote HistoryQuoted:
The Federal law is unconstitutional. Pass a Constitutional amendment or let it go. Quote HistoryQuoted:
Quoted:
Federal law says marijuana is illegal. He's doing his job. Sounds like a snowflake issue when you say a law enforcement officer shouldn't do his job because it unduly effects your ability to break the law. |
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