To recap , my situation was that Dr Porter told me I had to have cataract surgery, I in turn asked him if he had experience with RP and if there were any problems with having the surgery with RP, he told me he had RP patients ( now I know that is doubtful ) and told me there were never any complications ( now I know that RP patients are high risk ) So I thought I had no choice and I had the surgery, the vision in my " good " eye went from 20/40 to 20/100 plus. The head of Downing Mcpeak Vision Center , Dr Downing then asked that I come in and let him see if he could " fix " my vision, ( he fixed it alright, he talked me into another procedure that caused even more of the CME )
After Downing telling me he would help me and didn't, I have now found out that he could have, there were several things that he could have done, evidently they were more interested in covering their , you know whats . I posted once about how he could have done an implant called Retisert, ( Guess he would rather have left me blind than to have put out the money for that since it would have been about 50,000) I have also now found out that for people who do not respond to the steroid and nsaid drops , system steroids are helpful, of course I wasn't offered that either which should not be that expensive, guess my eyesight to them also isn't worth a few bucks. Several things that could have been done, including repositioning or replacing the IOL, which needed to be done anyway since the wrong powered lens was implanted into my eye by Dr Porter.
On top of being upset that I am still losing vision because of the dastardly deeds, I am also disappointed in the inhumanity of people who are supposed to be in the profession of helping people and yet only seem to be helping themselves!!
That is why we, as a society, must all work together to stop these greedy, uncaring and reckless doctors! We can start by reporting bad doctors to state medical boards, we can write our representatives and demand better health care, and we can make sure they are not cheating the insurance and medicare systems like so many of them seem to be, report them when you know they are billing for services not done, or upcoding , or performing unwarranted procedures etc, you can do this directly, or you can do it by filing a Qui Tam suit with a lawyer, if you file a Qui Tam suit , you will be entitled to a percentage of those fraudulently acquired funds, often large amounts, and be a patriotic hero!!
Showing posts with label fraud. Show all posts
Showing posts with label fraud. Show all posts
Sunday, July 26, 2009
Saturday, July 4, 2009
Happy 4th, Let Freedom Ring
The 4th of July represents everything that this country stands for, freedoms, goodwill and hope.
It isn't really free though, we all have an obligation to work to make this country a better place for ALL people. We do have an obligation to stand up for those who cannot stand up for themselves, one of those peoples being the elderly, the very young and the disabled. While looking at the statistics and the cases of doctors who have ripped off medicare by not providing the correct service to the elderly, or performing unnecessary procedures against others to line their own pockets, this is sad, and this demands our attention, a few of the horrendous cases listed below involve doctors taking advantage of the elderly, young kids, and even the mentally handicapped, we must stop fraudulent doctors from these practices, if you know of a doctor who is performing unnecessary procedures, or ripping off our system by over billing medicare, going into nursing homes and mistreating those there, get together the proof, turn them in, by doing so , you can even collect part of the recovered funds and help the unfortunate in doing so, help this country by keeping our health care cost down, saving taxpayers by stopping abuse of taxpayers monies, and keeping the quality of health care high. The Obama administration has promised to crack down on medical fraud, if you know of a doctor who is cheating the system and the patients, turn him in, here are some outrageous cases that have been caught....-------------------------------------------------------------------------------------------
Philip J. Gabriele, 44, and his wife, Marcella Gabriele, both of Granger, are accused of falsely and fraudulently diagnosing cataracts and other disorders in patients and performing unnecessary surgeries, according to a statement issued by assistant U.S. attorney Donald Schmid.
The indictment alleges that, as part of the fraud scheme, the defendants altered patient charts and records after the fact, in an effort to make it seem as if diagnoses were accurate and correct,
http://www.wsbt.com/news/local/47925197.html
The Gabrieles were found dead in their home, an apparent murder, suicide, only days after a 15 count indictment was handed down, investigation had been ongoing for a couple of years and now it will never be known exactly how many unnecessary surgeries were performed on adults and children ,,, June 19,2009
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An ophthalmologist accused of conducting unnecessary eye surgery on mentally ill residents of adult homes in New York City surrendered to the authorities yesterday and was charged with health care fraud, officials said.
http://www.nytimes.com/2002/05/24/nyregion/24HOME.html
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Cataract Removal
In 1993, the Agency for Health Care Policy and Research warned that many operations to remove a cataract, or clouded lens of the eye, are not necessary. In those cases, the clouding had probably reduced visual acuity, but not enough to bother the patient. Despite the warning, the number of cataract operations has continued to rise -- an increase that far outpaces the rise in the older population.
The best objective indicator that you might benefit from the surgery is having a cataract that reduces your visual acuity to 20/150 even with glasses. But subjective factors are more important: If the cataract does not hamper your daily activities, you don't need surgery, regardless of what any test shows.
If you suspect you have cataracts, you may want to avoid having your initial evaluation performed by an ophthalmologist whose practice consists mainly of cataract surgery -- one who works in a special cataract clinic, for example. Some evidence suggests that such doctors perform a greater proportion of cataract surgeries on minimally impaired eyes than other eye doctors do. (((( I WISH I had known this before going to Downing and McPeak Vision Centers ))))))))))
It isn't really free though, we all have an obligation to work to make this country a better place for ALL people. We do have an obligation to stand up for those who cannot stand up for themselves, one of those peoples being the elderly, the very young and the disabled. While looking at the statistics and the cases of doctors who have ripped off medicare by not providing the correct service to the elderly, or performing unnecessary procedures against others to line their own pockets, this is sad, and this demands our attention, a few of the horrendous cases listed below involve doctors taking advantage of the elderly, young kids, and even the mentally handicapped, we must stop fraudulent doctors from these practices, if you know of a doctor who is performing unnecessary procedures, or ripping off our system by over billing medicare, going into nursing homes and mistreating those there, get together the proof, turn them in, by doing so , you can even collect part of the recovered funds and help the unfortunate in doing so, help this country by keeping our health care cost down, saving taxpayers by stopping abuse of taxpayers monies, and keeping the quality of health care high. The Obama administration has promised to crack down on medical fraud, if you know of a doctor who is cheating the system and the patients, turn him in, here are some outrageous cases that have been caught....-------------------------------------------------------------------------------------------
Philip J. Gabriele, 44, and his wife, Marcella Gabriele, both of Granger, are accused of falsely and fraudulently diagnosing cataracts and other disorders in patients and performing unnecessary surgeries, according to a statement issued by assistant U.S. attorney Donald Schmid.
The indictment alleges that, as part of the fraud scheme, the defendants altered patient charts and records after the fact, in an effort to make it seem as if diagnoses were accurate and correct,
http://www.wsbt.com/news/local/47925197.html
The Gabrieles were found dead in their home, an apparent murder, suicide, only days after a 15 count indictment was handed down, investigation had been ongoing for a couple of years and now it will never be known exactly how many unnecessary surgeries were performed on adults and children ,,, June 19,2009
------------------------------------------------------------------------------
An ophthalmologist accused of conducting unnecessary eye surgery on mentally ill residents of adult homes in New York City surrendered to the authorities yesterday and was charged with health care fraud, officials said.
http://www.nytimes.com/2002/05/24/nyregion/24HOME.html
-------------------------------------------------------------------------------
Cataract Removal
In 1993, the Agency for Health Care Policy and Research warned that many operations to remove a cataract, or clouded lens of the eye, are not necessary. In those cases, the clouding had probably reduced visual acuity, but not enough to bother the patient. Despite the warning, the number of cataract operations has continued to rise -- an increase that far outpaces the rise in the older population.
The best objective indicator that you might benefit from the surgery is having a cataract that reduces your visual acuity to 20/150 even with glasses. But subjective factors are more important: If the cataract does not hamper your daily activities, you don't need surgery, regardless of what any test shows.
If you suspect you have cataracts, you may want to avoid having your initial evaluation performed by an ophthalmologist whose practice consists mainly of cataract surgery -- one who works in a special cataract clinic, for example. Some evidence suggests that such doctors perform a greater proportion of cataract surgeries on minimally impaired eyes than other eye doctors do. (((( I WISH I had known this before going to Downing and McPeak Vision Centers ))))))))))
Wednesday, May 27, 2009
$68 Billion Dollars in healthcare fraud
That is how much the US loses each year to health care fraud, 68 Billion Dollars! That is the amount not available to use for needed health care, for people that really need it, or to make health care better, or to lower costs, allthis money that is going down the drain costs everyone, it raises the cost of your premiums, it lowers the amount of services you get, it lowers the amount of quality health care available, it wastes taxpayers dollars.
More people need to turn in these companies that are over charging the health care system, are unbundling services in order to bill insurance or medicare a higher amount, or billing for services or procedures not rendered.
The US spends about 2 TRILLION Dollars a year in health care costs, so I can understand why we cannot afford to have better, bigger, all included , coverage, but we could get a lot closer if we had that 68 Billion dollars a year to use for the good of the people instead of for greedy doctors 2nd, third and fourth vacation homes!!!!
These links are a few that are trying to help the cause!!
http://www.nofreelunch.org/
http://www.wnd.com/index.php?pageId=64813
have you ever wondered whether your eyecare doctors have an incentive to
scam you??
http://www.jpands.org/vol11no4/gervais.pdf
More people need to turn in these companies that are over charging the health care system, are unbundling services in order to bill insurance or medicare a higher amount, or billing for services or procedures not rendered.
The US spends about 2 TRILLION Dollars a year in health care costs, so I can understand why we cannot afford to have better, bigger, all included , coverage, but we could get a lot closer if we had that 68 Billion dollars a year to use for the good of the people instead of for greedy doctors 2nd, third and fourth vacation homes!!!!
These links are a few that are trying to help the cause!!
http://www.nofreelunch.org/
http://www.wnd.com/index.php?pageId=64813
have you ever wondered whether your eyecare doctors have an incentive to
scam you??
http://www.jpands.org/vol11no4/gervais.pdf
Sunday, May 17, 2009
You and Fraud
What can you do about medical fraud? Actually, many things, it is up to people , ordinary people to stop fraud, by doing so you help people to not become victims, you help to stop the high cost of insurance, stop taxpayers dollars from being wasted, and improve the health care system!!!!
Share in the recovery
On top of this, if you are the first one to report fraud , you can be entitled to a percentage of the money that is recovered!! Often times this is 25 percent of the recovered amount! some examples,
will receive $1.75 million as his share ( florida April 14, 2008 )
will receive $1,020,000 as his statutory share of the proceeds ( california march, 2009 )
. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement ( washington 2007)
, will receive $412,500 as her share of the settlement ( Illinois 2008 )
Not to even mention that you will be doing a world of good.
There were many companies out there that had someone in the inside, or someone who used the company and knew of illicit goings on, had reported them, then they could have stopped the company from going bankrupt, stopped them from losing employee retirements etc.
Is it your ethical duty?
In a nutshell, yes. People are harmed by fraudulant acts, if it is overbilling they are harmed by higher costs of insurance, or taxes if medicare is over billed, if it is by opthamologists performing unwarranted surgeries, you can save patients harm, there are many ways it helps to put a stop to fraud or abuse!
How can you help?
Here are a few law firms that take cases, I do not have any connection to any of these.
Toll Free 1 (888) 482-6825
Tel: 202.833.4567212) 376-5666 1-888-933-1514
1-888-775-3779
Attorney General Conway Announces Optometrist Indictment ( kentucky )
Citizens are urged to report suspected fraud or elder abuse by calling the Attorney General’s tip line at 1-877-ABUSE TIP (1-877-228-7384).
What kinds of fraud to look for ? some examples are.
Services not rendered
Upcoding schemes and Unbundling
Kickbacks and Self Referrals
Falsely Certifying and Giving False Information
Lack of Medical Necessity
Fraudulent Cost Reports
Grant or Research Fraud
SERVICES NOT RENDERED:
The simplest scheme of healthcare fraud is the billing for services that were never rendered to patients.
Examples under this scheme include healthcare providers billing Medicare or Medicaid for services that were never performed, medical supplies and equipment that were never delivered, and lab or medical tests that never occurred.
UPCODING AND UNBUNDLING:
Upcoding
Another common scheme involves upcoding to obtain a higher reimbursement than one is entitled to. Medicare and Medicaid systems use a set of billing codes which healthcare providers use in billing for services. These codes are known as the HCPCS codes. In an upcoding scheme, providers wrongfully use a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment. These codes are billed electronically and typically slip through the system unless caught through a random audit of only approximately 2% of the claims each year. The only other way to catch the fraudulent use of these higher codes is for an insider to come forward and report the upcoding.
Unbundling
Another common example of coding fraud is called "unbundling." When procedures or lab tests involve a number of related services or tests that are typically performed together, Medicare and Medicaid have specific billing codes that must be used to obtain reimbursement for all of the associated services or tests as a whole, rather than allowing reimbursement for each of the related services or tests billed separately.
KICKBACKS:
A federal statute known as The Stark Law, is designed to prevent billing for Medicare services resulting from abusive self-referrals and kickbacks. Under the Stark Law, a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider, unless an exception applies.
Examples
an HMO provider had come under increasing pressure to switch from an equally effective but significantly less expensive alternative drug because the pharmaceutical company offered its doctors a panoply of inducements to prescribe the expensive drug, including ski and golfing trips, free televisions and VCRs, cocktail party bar tabs, and an array of free products and services.
FALSE CERTIFICATIONS AND INFORMATION:
Health care providers are required to act openly and honestly with the Medicare and Medicaid programs and submit claims based upon accurate information. In addition, Medicare providers are required to disclose all known errors and omissions in their claims for Medicare reimbursement. Providers who submit false claims in violation of these requirements violate the False Claims Act.
Examples
In Mississippi, a hospital chain agreed to a $1.5 million settlement of a qui tam lawsuit in which it was alleged that the hospital billed under physician provider numbers when, in fact, the services were rendered by nurses rather than physicians.
LACK OF MEDICAL NECESSITY:
It is improper to bill Medicare for services or treatment that is not medically necessary. To knowingly do so is a violation of the False Claims Act.
Examples
In New York, an ophthalmologist agreed to pay a settlement of $8.5 million for performing medically unnecessary, contraindicated, and unperformed ophthalmologic services. The settlement agreement provided that the doctor would be permanently excluded from all federally funded health care programs. The physician’s own medical charts did not justify the wide scope of services for which he submitted bills. He also created and submitted new documentation, sometimes years after the questioned dates of service, to attempt to justify his claims after Medicare requested supporting documentation.
In Illinois, a physician group filed false claims for reimbursement to Medicare and Medicaid by submitting claims for inpatient services that were not supported by sufficient documentary evidence and filed claims for both inpatient and outpatient services that were wrongly coded. The physician group agreed to pay an $8.275 million settlement.
An optometrist billing for the comprehensive eye exam when he or she performed the lower level exam
An ophthalmologist falsifying documentation for a test that is used to establish the need for cataract surgery
Audits by the Office of the Inspector General reveal that $1 out of every $7 spent on
Medicare and Medicaid is lost due to fraud and abuse. This problem affects everyone.
It affects those who depend on these programs by diminishing the quality of treatment
they receive. It affects families and caregivers by decreasing the funding available for
important health care support. It affects all taxpayers by wasting billions of dollars per
year.
Share in the recovery
On top of this, if you are the first one to report fraud , you can be entitled to a percentage of the money that is recovered!! Often times this is 25 percent of the recovered amount! some examples,
will receive $1.75 million as his share ( florida April 14, 2008 )
will receive $1,020,000 as his statutory share of the proceeds ( california march, 2009 )
. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement ( washington 2007)
, will receive $412,500 as her share of the settlement ( Illinois 2008 )
Not to even mention that you will be doing a world of good.
There were many companies out there that had someone in the inside, or someone who used the company and knew of illicit goings on, had reported them, then they could have stopped the company from going bankrupt, stopped them from losing employee retirements etc.
Is it your ethical duty?
In a nutshell, yes. People are harmed by fraudulant acts, if it is overbilling they are harmed by higher costs of insurance, or taxes if medicare is over billed, if it is by opthamologists performing unwarranted surgeries, you can save patients harm, there are many ways it helps to put a stop to fraud or abuse!
How can you help?
Here are a few law firms that take cases, I do not have any connection to any of these.
Toll Free 1 (888) 482-6825
Tel: 202.833.4567212) 376-5666 1-888-933-1514
1-888-775-3779
Attorney General Conway Announces Optometrist Indictment ( kentucky )
Citizens are urged to report suspected fraud or elder abuse by calling the Attorney General’s tip line at 1-877-ABUSE TIP (1-877-228-7384).
What kinds of fraud to look for ? some examples are.
Services not rendered
Upcoding schemes and Unbundling
Kickbacks and Self Referrals
Falsely Certifying and Giving False Information
Lack of Medical Necessity
Fraudulent Cost Reports
Grant or Research Fraud
SERVICES NOT RENDERED:
The simplest scheme of healthcare fraud is the billing for services that were never rendered to patients.
Examples under this scheme include healthcare providers billing Medicare or Medicaid for services that were never performed, medical supplies and equipment that were never delivered, and lab or medical tests that never occurred.
UPCODING AND UNBUNDLING:
Upcoding
Another common scheme involves upcoding to obtain a higher reimbursement than one is entitled to. Medicare and Medicaid systems use a set of billing codes which healthcare providers use in billing for services. These codes are known as the HCPCS codes. In an upcoding scheme, providers wrongfully use a higher paying code to fraudulently reflect that a more expensive procedure or device was involved in the patient’s treatment. These codes are billed electronically and typically slip through the system unless caught through a random audit of only approximately 2% of the claims each year. The only other way to catch the fraudulent use of these higher codes is for an insider to come forward and report the upcoding.
Unbundling
Another common example of coding fraud is called "unbundling." When procedures or lab tests involve a number of related services or tests that are typically performed together, Medicare and Medicaid have specific billing codes that must be used to obtain reimbursement for all of the associated services or tests as a whole, rather than allowing reimbursement for each of the related services or tests billed separately.
KICKBACKS:
A federal statute known as The Stark Law, is designed to prevent billing for Medicare services resulting from abusive self-referrals and kickbacks. Under the Stark Law, a physician is prohibited from making any referral to a provider of designated health services if the physician has a "financial relationship" with the provider, unless an exception applies.
Examples
an HMO provider had come under increasing pressure to switch from an equally effective but significantly less expensive alternative drug because the pharmaceutical company offered its doctors a panoply of inducements to prescribe the expensive drug, including ski and golfing trips, free televisions and VCRs, cocktail party bar tabs, and an array of free products and services.
FALSE CERTIFICATIONS AND INFORMATION:
Health care providers are required to act openly and honestly with the Medicare and Medicaid programs and submit claims based upon accurate information. In addition, Medicare providers are required to disclose all known errors and omissions in their claims for Medicare reimbursement. Providers who submit false claims in violation of these requirements violate the False Claims Act.
Examples
In Mississippi, a hospital chain agreed to a $1.5 million settlement of a qui tam lawsuit in which it was alleged that the hospital billed under physician provider numbers when, in fact, the services were rendered by nurses rather than physicians.
LACK OF MEDICAL NECESSITY:
It is improper to bill Medicare for services or treatment that is not medically necessary. To knowingly do so is a violation of the False Claims Act.
Examples
In New York, an ophthalmologist agreed to pay a settlement of $8.5 million for performing medically unnecessary, contraindicated, and unperformed ophthalmologic services. The settlement agreement provided that the doctor would be permanently excluded from all federally funded health care programs. The physician’s own medical charts did not justify the wide scope of services for which he submitted bills. He also created and submitted new documentation, sometimes years after the questioned dates of service, to attempt to justify his claims after Medicare requested supporting documentation.
In Illinois, a physician group filed false claims for reimbursement to Medicare and Medicaid by submitting claims for inpatient services that were not supported by sufficient documentary evidence and filed claims for both inpatient and outpatient services that were wrongly coded. The physician group agreed to pay an $8.275 million settlement.
An optometrist billing for the comprehensive eye exam when he or she performed the lower level exam
An ophthalmologist falsifying documentation for a test that is used to establish the need for cataract surgery
Audits by the Office of the Inspector General reveal that $1 out of every $7 spent on
Medicare and Medicaid is lost due to fraud and abuse. This problem affects everyone.
It affects those who depend on these programs by diminishing the quality of treatment
they receive. It affects families and caregivers by decreasing the funding available for
important health care support. It affects all taxpayers by wasting billions of dollars per
year.
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