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Thread: Medicare fraud

  1. #1
    Cyburbian hilldweller's avatar
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    Medicare fraud

    It's ridiculous how ripe for abuse our health care system is, but performing unnecessary heart operations to maximize profit has to be a new low:

    http://www.msnbc.msn.com/id/48542945...6#.UCEWS9ln58E

    Thought this was an interesting tidbit:
    But the pressure is even greater for HCA. In 2000, the company reached one of a series of settlements involving a huge Medicare fraud case with the Justice Department that would eventually come to $1.7 billion in fines and repayments. The accusations, which primarily involved overbilling, occurred when Rick Scott, now the governor of Florida, was the company’s chief executive. He was removed from the post by the board but was never personally accused of wrongdoing.
    Just astounding, really.

  2. #2
    OH....IO Hink's avatar
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    The context of this story is pretty bad really.... this part gets me the most.

    At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.
    Want to know what is wrong with healthcare? You only need to search for the paid doctors who will justify any lawsuit. I am not saying that this case isn't justified or that HCA didn't knowingly facilitate such actions, but the reality is that most likely this isn't as horrible as it sounds.

    It is articles like this and this - http://www.dallasnews.com/opinion/su...much-money.ece that try to make it out like all doctors are out to get people.

    I am not going to say that there is most likely something fishy going on there, but I strongly doubt that most doctors are performing medicare fraud for fun. Most (not all) are put in situations where they have to make a medical decision that needs to be made now, and can be reviewed and Monday morning quarterbacked forever afterward. If that Doctor wouldn't have cared for the person, they could be sued for "missing" the irregular heartbeat, or clot. I don't know the whole story, so I am not going to make a judgment either way, but with how extremely biased and uninformed most media (and the general public) is on the realities of healthcare, my guess is that there was wrongdoing by few, and others might have done wrong but not maliciously. In a group that has 160 hospital and likely thousands of doctors, 4 bad ones, makes the whole operation bad or trying to bilk the general public? I think not.

    In a confidential memo prepared in December 2004 and reviewed by The Times, CardioQual concluded that as many as 43 percent of 355 angioplasty cases, where doctors performed invasive procedures to open up a patient’s arteries, were outside reasonable and expected medical practice.

    Worse, the investigation revealed that some physicians had indicated in medical records that the patients had blockages of 80 to 90 percent when a later, more scientific analysis of a sampling of cases revealed the blockages had ranged from 33 to 53 percent.
    If this is true, which is a big if, that is horrible. I would be interested to see the "more scientific analysis".

    I am not defending bad doctors. I am defending good doctors who look bad when articles like these are published with likely half truths, or not the full facts.

    ps. As a response to the article above a Doctor actually set the record straight.... http://www.meandmydoctor.com/2012/07...octor-pay.html
    A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools. -Douglas Adams

  3. #3
    Cyburbian hilldweller's avatar
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    Quote Originally posted by Hink View post

    It is articles like this and this - http://www.dallasnews.com/opinion/su...much-money.ece that try to make it out like all doctors are out to get people.
    The article suggests that the hospital company was putting pressure on the doctors to perform these questionable/unnecessary heart procedures in order to fatten up their bottom line. Since many of the doctors are probably foreign and have obtained their green cards obtained through their employer, you can definitely bet they feel pressured to follow orders.

    Consider the case of a friend of mine. She is from India and her employer (a company which recruits doctors/surgeons and contracts with hospitals on surgeries) sponsored her green card. I'm not sure how it works exactly, as far as the immigration rules, but she told me she is essentially bound to her employer. I think her visa is contingent on her employment with her sponsor, so she's basically an indentured servant (albeit a highly-educated and well-paid one). Also, even though she is a doctor, she doesn't get to determine which cases (surgeries) she works on. That is decided by her company and the hospital.

    I admit that my "knowledge" of surgical practice is second-hand, but I believe the issues are more complex than just a "greedy doctor" scenario.

  4. #4
    Cyburbian ofos's avatar
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    Quote Originally posted by hilldweller View post
    The article suggests that the hospital company was putting pressure on the doctors to perform these questionable/unnecessary heart procedures in order to fatten up their bottom line. Since many of the doctors are probably foreign and have obtained their green cards obtained through their employer, you can definitely bet they feel pressured to follow orders.

    Consider the case of a friend of mine. She is from India and her employer (a company which recruits doctors/surgeons and contracts with hospitals on surgeries) sponsored her green card. I'm not sure how it works exactly, as far as the immigration rules, but she told me she is essentially bound to her employer. I think her visa is contingent on her employment with her sponsor, so she's basically an indentured servant (albeit a highly-educated and well-paid one). Also, even though she is a doctor, she doesn't get to determine which cases (surgeries) she works on. That is decided by her company and the hospital.

    I admit that my "knowledge" of surgical practice is second-hand, but I believe the issues are more complex than just a "greedy doctor" scenario.
    I don't know how your friend's contract is structured but I suspect it is similar to ones that I saw done in the information systems consulting business. The consulting company (aka employer) recruits employees from, in this case India, at rates that seem great in comparison to the local economy but are, in fact, much lower than U.S. pay scale. Having lower rate employees allows the company to get consulting agreements that undercut American competition but still give large margins to the consulting company. Because the consulting company is the green card sponsor, they have a very tight grip on their "consultants." If the consulting company is also helping manage the hospital case load, there is even more opportunity to skim.
    “Death comes when memories of the past exceed the vision for the future.”

  5. #5
    OH....IO Hink's avatar
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    Quote Originally posted by hilldweller View post
    The article suggests that the hospital company was putting pressure on the doctors to perform these questionable/unnecessary heart procedures in order to fatten up their bottom line. Since many of the doctors are probably foreign and have obtained their green cards obtained through their employer, you can definitely bet they feel pressured to follow orders.

    Consider the case of a friend of mine. She is from India and her employer (a company which recruits doctors/surgeons and contracts with hospitals on surgeries) sponsored her green card. I'm not sure how it works exactly, as far as the immigration rules, but she told me she is essentially bound to her employer. I think her visa is contingent on her employment with her sponsor, so she's basically an indentured servant (albeit a highly-educated and well-paid one). Also, even though she is a doctor, she doesn't get to determine which cases (surgeries) she works on. That is decided by her company and the hospital.

    I admit that my "knowledge" of surgical practice is second-hand, but I believe the issues are more complex than just a "greedy doctor" scenario.
    I might have misread your intent. I am somewhat touchy on this topic I admit....
    A common mistake people make when trying to design something completely foolproof is to underestimate the ingenuity of complete fools. -Douglas Adams

  6. #6
    Cyburbian imaplanner's avatar
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    It's a big money maker, and usually the people who profit the most from it don't go to jail even after their companies are caught doing it. Instead they go on to be the Governor of Florida or quite possibly our next president of the US (google Romney medicare fraud). Nobody really cares about fraud.

    Fraud is essentially a part of investment business now. Check out the LIBOR scandal, where so far companies have paid fines well below the amount they made off the fraud and nobody goes to jail.
    Children in the back seat can cause accidents - and vice versa.

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