Provided by Kaiser Health News.
Law enforcement officers fanned out across five states Friday in what federal officials called the largest Medicare fraud bust ever conducted. Nearly 100 people were indicted in frauds that totaled $251 million.
The Associated Press: “Several doctors and nurses were among those arrested in Miami, New York City, Detroit, Houston and Baton Rouge, La., accused of billing Medicare for unnecessary equipment, physical therapy and HIV treatments that patients typically never received. Ninety-four suspects were indicted, and authorities said 36 people had been arrested as of Friday morning. … ‘With today’s arrests we’re putting would-be criminals on notice: health care fraud is no longer a safe bet,’ [Attorney General Eric] Holder said Friday. … [T]he schemes involve a sophisticated network of doctors, clinic owners, patients and patient recruiters. Violent criminals and mobsters are also tapping into the scams, seeing Medicare fraud as more lucrative than dealing drugs and having less severe criminal penalties, officials said” (Kennedy, 7/16).
The Washington Post: “The arrests came as Attorney General Eric H. Holder Jr. and Health and Human Services Secretary Kathleen Sebelius held the first in a series of regional ‘summits’ on health-care fraud prevention in Miami. The high-level attention marked the latest step in crackdown on fraud that the Obama administration has said is a key part of its agenda on health-care reform. … The cost of Medicare, which covers the elderly and disabled, and Medicaid, its sister program for the poor, are growing as the American population ages, giving new urgency to initiatives to detect and prevent phony claims. Health-care fraud is believed to rob the nation’s coffers of billions of dollars each year. In May 2009, the administration launched a high-level task force, the Health Care Fraud Prevention and Enforcement Action Team, which uses electronic claims data — and the threat of federal prosecution — to seek out illicit billing” (Markon, 7/16).
CNN: “Charges include filing fraudulent claims for HIV/infusion services, home health care, physical therapy and durable medical equipment. The Medicare Fraud Strike Force is a joint effort by the Department of Justice and the Department of Health and Human Services. The team works with federal, state and local investigators to analyze Medicare data and emphasizes community policing” (Chernoff and Steffen, 7/16)
The Wall Street Journal: “In Brooklyn, the government charged, among others, doctors Gustave Drivas and Jonathan Wahl and their partners. … The medical clinics run … paid Medicare patients cash to entice the patients to get extra unnecessary treatment so that Medicare would be billed more, prosecutors said. The patients were paid in what the government referred to as ‘the Kickback room,’ a room marked private that only featured for decoration a poster with a woman holding her finger to her lips and, written in Russian, the words ‘Don’t Gossip.’ … In all, the government said Mr. Drivas’s group billed Medicare for nearly $72 million and received $46.9 million in reimbursements. The eight have been each been charged in a criminal complaint with one count of conspiracy to commit health care fraud. Four other criminal complaints by the U.S. Attorney’s Office in Brooklyn were filed against a total of 14 other defendants involving four separate schemes” (Benoit, 7/16).
The Miami Herald: “About 25 suspects, including longtime general practitioner Dr. Jorge J. Dieppa, were charged in Miami-Dade County for allegedly submitting about $103 million in fraudulent bills for home healthcare, HIV therapy and medical equipment services, according to federal indictments. … Dieppa, 56, whose practice is in Miami’s Flagami neighborhood, is accused of receiving kickbacks for making hundreds of patient referrals to home healthcare agencies for costly diabetic services that were unnecessary” (Weaver, 7/16).
Detroit Free Press: “‘We want to make sure that providers out there know we are looking at you,’ Assistant U.S. Attorney Barbara McQuade said at a news conference in Detroit. ‘If you are making false billings, you will be brought to justice.’ … Those arrested in the metro Detroit cases were responsible for $35 million in Medicare fraud, authorities said. … McQuade and Detroit FBI chief Andrew Arena said economically distressed areas like metro Detroit are hot spots for Medicare fraud, which prompted McQuade to assign more people to prosecute such cases” (Ashenfelter, 7/16).
This is part of Kaiser Health News’ Daily Report – a summary of health policy coverage from more than 300 news organizations. The full summary of the day’s news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.
This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.
Great job. The next step is to go after corrupt politicians who spend taxpayer dollars on wasteful spending and useless projects and receive money from special interest groups in return for the political favors. Next, we can bust the malpractice lawyers who line their pockets with dough squeezed from physicians and hospitals for ludicrous claims.
Nah, that stuff can wait. First, the doctors must be exposed for the greedy fraudulent evil-doers that they are. That way gov’t can pile on regulations such as billing fraud for which a doctor can be prosecuted even if it was by mistake or if it was performed by office staff. Yes, those doctors are guilty until proven otherwise.
NICE, go ahead and feed the general public the same crap you’ve always been feeding them. Doctors are evil people, they’re after everyone’s money, they are heartless, they don’t care, they go into medicine for the money, blah blah blah. Never mind the corruption that’s rampant all over DC and the whole country. Never mind letting medical students graduate with over 400K in debt, and essentially forcing them to slave away the next 20-30 years of their lives trying to pay that back with interest. Never mind losing your freakin’ 20′s and half your 30′s with a smile on your face because you want to help people, only to realize that there are people out there that are HEARTLESS to the point where they can write a comment like Yammo’s comment above – who are so clueless and ignorant that they would be absolutely baffled if they were ever in a physician’s shoes.
There’s a reason why every doctor now keeps telling his/her kids to stay away from medicine. The average salary of a physician hasn’t increased a single CENT in the last 20 years while every other profession on earth has increased its salaries with at least the amount of inflation. I have never in my life seen a country destroying its physicians and medicine the way Americans are right now. Go ahead! After all, it’s all because of them doctors!!! Just don’t come and bitch about not being able to see your family doctor this week or the next week because he’s busy. Remember that you’re the one who forced him/her to start practicing defensive medicine, and you’re the one who made it too expensive to see you. Go ahead, have fun with the nurses, PA’s, DNP’s, and every other midlevel provider who is jumping up and down excited to take your money. In a few years, when thirld world countries have more physicians than you do, you will start asking yourself whether you did the right thing. The physicians mentioned in this article are a disgrace to the profession. What they did was very wrong, but every profession has those bad guys. It’s not an excuse to hate us even more. Shame on you Yammo for singling us out like that.
I think Yammo was being sarcastic.
Why is SDN so enamoured with the leftist Kaiser News?
Crack down on Medicare fraud, my arse. Tell me how much did you have to pay these agents, and then do the math whether the operation actually saved any money.
Today I will order extra lab study or two just because I can. Come and arrest me.
The best and only way to get rid of the waste and fraud in medicine is to (1) get government out of medicine, (2) make people pay for their healthcare.
Just did a search and found that all of these doctors are FMG/IMGs.
Dr. Jorge J. Dieppa – Inst Sup De Cien Med
Dr. Gustave Drivas – Ross University
Dr. Jonathan Wahl – Ross University
Whoa there, hold your horses MDman – I was being sarcastic. Sorry I didn’t make that clearer, I was writing from my PDA. I’m a med student myself, and your comment is 100% right (it’s just the criticism which is misdirected
.
Erbe, I second your thoughts – why does SDN keep on bringing us this socialist trash? Don’t they realize that it’s not the 70s anymore, we’re not on crack, and liberal-socialism is not “in” anymore? I mean, aren’t they reading the comments?
By the way, Erbe, notice the picture accompanying this article: A doctor in scrubs stiffing a wad of dollars in his pocket. How much more twisted can this topic get? I mean, check out the back- and front-cover pages of the phone books, plus the middle full-color pages. Any doctors there? No, only malpractice lawyers with the most artificial plastic smiles plastered on their sick faces, bragging about multi-million settelments and lawsuits they won “for their clients” (as if their clients see a significant amount from it). Need I go on? This world has it’s priorities in reverse.
MDman, your sentiments were totally justified. We’re being screwed right and left. Sorry again for raising your BP.
I’m really sorry Yammo. I totally misread your comment. Was having a bad day, thank you very much for understanding!
I’m about to go ino my second year of med school and wondering if I should drop everything and run now. I want to be able to pay off my loans- probably amassing to about 160,000 when I’m done. How the fuck do I get that paid off while still trying to enjoy my life and find myself in a foreign country? Looking at all the people going into medicine there must be some kind of incentive, or are we all just doomed to be corporate drones?
As I tell my friends. Those of us who love science and medicine are cursed. We are doomed to have a long and miserable life trying to make a difference. Why? Nobody gives a damn! All Americans are concerned about is money. If you drive a nice car and live in a Huge house, you are considered successful. If you are a physician and live in an apt and drive a piece if shit car. You are considered a loser. Nobody gives a rats ass about our goal of making a difference. People would consider Lindsey Lohan more successful than a cardiothoracic surgeon. Why? Because Lohan makes $20 million a year and a cardiothoracic surgeon makes $500,000/yr. Screw helping people!!!! They can call Glenn Beck if they need medical advise.
i’m just starting medical school so i don’t really understand insurance and billing and all that stuff, but i don’t see how some of your comments are justified. if these charges are proven to be true, i don’t see why they shouldn’t be punished. just because we’re gonna be in huge debt doesn’t give us the right to break the law to make some extra money. and i don’t think 100 million dollars was billed ‘by mistake’. i’m sure many many doctors don’t bill unnecessarily, how is that fair to them? also, i don’t see how, if you truly only billed for necessary procedures, you would not make enough money to survive. there are sick people everywhere man.
don’t get me wrong, the government should definitely focus their resources going after corrupt politicians etc etc…there are way worse people in the world. doctors gave a HUGE part of their lives to practice medicine, a lot more than many people would. i don’t think that gives them entitlement to do wrong, though.
Hey Someone,
First of all, welcome to the medical student club!! As a forward, while we b!^ch about a whole lot in our free time, the stuff you’re about to learn is really exciting and you’ll find out that being a doctor is truly a privilage.
What bothers us isn’t that they busted medicare fraud, rather how it’s being handled. Primary care docs are not getting paid well for the work they do – and it’s not due to a lack in patients…rather, there are only so many patients a doctor can see without seriously compromising patient care and a smoothly-running office. There are many, many things a PCP does w/o getting paid. They run around like crazy taking phone calls, reviewing reports, examining lab and imaging results and writing prescriptions – all w/o getting paid, b/c they only get paid per patient and they do very few procedures (unfortunately, procedures are the big money makers). On top of that, there’s billing paperwork which needs to be done/paid for and office staff to reimburse if you’re in private practice. On top of that, medicare and medicaid pay *bobkes* (that’s the analagous Yiddish term for “peanuts”), and the payments are usually delayed. Since PCP physicians are the main H/C providers for of medicare/medicaid patients, they make even less. It is no wonder that fewer and fewer doctors are accepting medicare, let alone madicaid. It’s simply not affordable. Hence, if you truly analyze the situation, the party at fault for this is the government who is running medicare into bankruptcy to begin with.
The outrageous part is that instead of focusing on the rampant, easily stoppable corruption and embezzelment in the law and politics community, they focus on the population that saves lives and heals people. They do everything to portray doctors as greedy, money-hungry people who “go into medicine for the money” (just look at this article’s picture). They pass laws to make it more difficult for doctors to practice medicine economically, and they don’t take measures to stop the out-of-hand litigational party that malpractice lawyers (the true greedy monsters) have in suing doctors and hospitals [parenthetically, this raises the costs for hospitals and doctors, who of course have to pass the cost on to the insurance companies and the patients. Hence, these lawyers are padding their bank accounts with your money]. Instead of warning off potential political embezzelers by cracking down on corruption, they intimidate the medical community as a whole so now doctors will really have to watch their backs even more than before.
Someone, you sound like a nice person who is sincerely bothered by the fraud, which you should be. However, if you put the gov’t's atittude and method into perspective, and if you talk to PCPs about what they go through, you’ll find that our anger is anything but unfounded. While primary care should be one of the best professions from many aspects (as it used to be), you’ll find out that in the current environment, it stinks to become a PCP. While fraud is stealing and wrong, the moral threshold for these doctors were lowered by their need to come out profitable or break even, and they got a bit carried away (to say the least).
A word of warning: as you begin medical school, you’ll also be preached to by doctors, who will be retiring before or shortly after the heathcare “reform” takes full effect, about how medicine will always be the best profession even if you don’t make so much money. You may have the urge to wring their pompous, self-rightous, fat necks. Resist that urge, murdering a preceptor doesn’t look good on your transcript.
On a side note, it’s really up to us if we’re going to let this happen, and that’s through our votes. If we keep electing lawyers, community activists and university professors (i.e. people who’ve never held real jobs), the situation for doctors and patients will keep worsening.
Let me share with you what happened in 2008:
In the last election, there was a wonderful guy running for Congress in my state (MD). Not only was he a really friendly family guy, but he’s also an OB-Gyn. Now, OB-Gyns are leaving Maryland EN MASSE, and very few Marylanders are going into OB, because of the sky-high malpractice premiums they would have to pay and the extremely protective method by which they have to practice. So why did they not elect this OB-Gyn, who could have done so much for MD and for the country to shape healthcare the way WE KNOW needs to be done? Because he’s a republican, and MD is a blue state…As a result, we’re not getting anywhere with any useful legistlation to help doctors help their patients. Once again, MD is screwed b/c of lawyers and voter stupidity. Let’s hope our country gets its act together before the midterm elections.
Phew! Enough for today.
On a side note, it’s really up to us if we’re going to let this happen, and that’s through our votes. If we keep electing lawyers, community activists and university professors (i.e. people who’ve never held real jobs), the situation for doctors and patients will keep worsening.
Let me share with you what happened in 2008:
In the last election, there was a wonderful guy running for Congress in my state (MD). Not only was he a really friendly family guy, but he’s also an OB-Gyn. Now, OB-Gyns are leaving Maryland EN MASSE, and very few Marylanders are going into OB because of the sky-high malpractice premiums they would have to pay and the extremely protective method by which they would have to practice. So why did they not elect this OB-Gyn, who could have done so much for MD and for the country to shape healthcare the way WE KNOW needs to be done? Because he’s a republican, and MD is a blue state…As a result, we’re not getting anywhere with any useful legistlation to help doctors help their patients. Once again, MD is screwed b/c of lawyers and voter stupidity. Hopefully our country can get its act together before the midterm elections.
Phew! Enough for today.
Sorry for the double post…
yammo, thanks for the reply! i see where you’re coming from and i can understand how ridiculous it is. it’s really disturbing to know that someone, who could do such good for our country, won’t be elected because of party politics. i’m definitely NOT looking forward to that aspect of medicine at all. it sounds like the biggest pain in the a**.