Report on Medicare/Medicaid Overbilling and Fraud in 2007 Focuses on Nursing Homes/Rehab Centers, Pharmaceuticals and Boutique Hospitals

Americas Watchdog and its Corporate Whistleblower Center have just released the results of its third annual study focused on Medicare & Medicaid fraud. The report continues to show widespread Medicare/Medicaid billing abuse and fraud involving all aspects of health care.

The Corporate Whistle Blower Center has just reported its 2007 year end findings on the state of Medicare/Medicaid over billing/fraud in the United States. The report included three areas where Medicare/Medicaid are being over-billed or defrauded; nursing homes/rehab centers, pharmaceuticals, and boutique hospitals, not for profits hospitals, or hospitals owned by doctors/investor groups.

1. Most Nursing Homes/Rehab Centers continue to not provide anything close to mandatory time/hours per day with patients under their care. Nursing homes, rehab centers, and in some cases hospitals are required by Medicare/Medicaid to spend minimum hours per day, per patient. The report indicated that less than 50% of Medicare/Medicaid patients are getting the mandatory hours per day in care, putting the patient at risk and exposing the tax payer to a bill that should not have been paid.

The Corporate Whistleblower Center says,” senior citizens are dying in US nursing homes, because they are in many cases, not getting anything close to mandatory time/hours per day in care”.

The other issue with nursing homes is that they are in many cases staffed, with undocumented workers acting as health care providers. Many nursing homes also continue to over bill Medicare/Medicaid for unnecessary testing of patients, who do not need to be tested. Unnecessary testing includes speech, cognitive or related areas. The study indicated that 35% of all nursing home testing might be unnecessary.

2. Doctors prescribing the most expensive drugs (rather than generics) or medical devices also account for up to 15% of all Medicare/Medicaid over-billings. While doctors can no longer take trips, or get rewards directly from drug makers/device makers for prescribing the most expensive drugs/device; they can become a “consultant” for the drug/medical device company, and end up with the same type of benefit.

According to Americas Watchdog, ” the big drug companies/device makers categorize the physician as a consultant and he/she then gets paid, or they get to go to a vacation spot where they are treated to free first class hotel accommodations, etc. “All they have to do is give a talk, (to a possibly empty room), for an hour”. Rather than prescribe the least expensive drug or medical devices, some physicians prescribe the most expensive out of loyalty to the drug company, or medical device maker. According to Americas Watchdog, this costs taxpayers “billions”.

Americas Watchdog also noted that drug companies have been allowed to have way to much influence with the White House, the US Congress & Senate. “Why is it cheaper to buy drugs in Canada, than it is in the US? Over priced drugs cost US taxpayers dearly. How can we have Presidential debates, with no mention of drug companies and inflated prices”?

3. Boutique hospitals, not for profits hospitals, or hospitals owned by doctors/investor groups are largely unregulated. These types of hospitals are not typically on any federal, or state Medicare or Medicaid radar screen. The study indicated that many faith based or State or Country owned hospitals are over-billing the federal government.

The report indicated not for profit hospitals and state or county facilities routinely over bill the Federal Government. The report indicated the over billing the federal government on the part of not for profits, and or county/state hospitals could be 10 billion dollars a year or more.

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