Fighting Medicare fraud is important, right?

But when you see so many cases like those listed on this website, especially for mental health care, you begin to wonder…  Who’s deciding whether the health care and/or prescribed drugs were reasonable and medically necessary or not?  What happens to the patients when the government shuts down all these doctors and clinics?

After paying these fines, will providers/hospitals change their behavior and refuse to treat some patients?  And by the way, where does all this money go?  Not back to the patients who may have been victims, that’s for sure.

https://oig.hhs.gov/fraud/enforcement/criminal/

May 6, 2015:  A Houston doctor and a group home owner were arrested on charges related to their alleged participation in a $5.2 million Medicare fraud scheme involving false claims for mental health treatment.

May 14, 2015:  PharMerica Corporation has agreed to pay the United States $31.5 million to resolve a lawsuit alleging that they violated the Controlled Substances Act by dispensing Schedule II controlled drugs without a valid prescription and violated the False Claims Act by submitting false claims to Medicare for these improperly dispensed drugs, the Justice Department announced today.

May 7, 2015:  Sixteen Hospitals to Pay $15.69 Million to Resolve False Claims Act Allegations Involving Medically Unnecessary Psychotherapy Services.  The Justice Department announced today that 16 separate hospitals and their respective corporate parents have agreed to collectively pay $15.69 million to resolve False Claims Act allegations that the providers sought and received reimbursement from Medicare for services that were not medically reasonable or necessary, the U.S. Department of Justice announced today.

May 1, 2015:  Settlement With Accredo Health Group Over Kickback Scheme Involving Prescription Drug.  Preet Bharara… announced yesterday a $60 million settlement of a civil fraud lawsuit against ACCREDO HEALTH GROUP (“ACCREDO”) concerning a kickback scheme with NOVARTIS PHARMACEUTICALS CORP. (“NOVARTIS”) involving the prescription drug Exjade… In connection with the scheme, the defendants understated the serious and potentially life-threatening side effects of Exjade when promoting the drug’s benefits to patients.

Big Pharma understates the side effects of medications every day in commercial after commercial.  Should pharmaceutical companies overstate the side effects?  Seems like a pretty fine line to end up somewhere in between understate and overstate.  And because of the long list of side effects for every drug, I don’t think Americans even pay attention to that stuff anymore.

There’s no doubt that Medicare fraud happens every day, but no one in law enforcement ever considers the consequences of their actions for the patients.  All they’re concerned with is who they think is committing fraud, and saving money for Medicare

3 thoughts on “Fighting Medicare fraud is important, right?

  1. I’m with you to a point, but honestly there is usually some form of due to process to ensure that the schemes were indeed fraudulent. The medically necessary rules are a bit more tricky and definitely mental health services are not seen as real issues by too many people.

    Liked by 1 person

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