Medicare Fraud: Big League Faking It

Mike Riggs | June 13, 2008

How much more common would this problem be under a universal healthcare system?

Rita Campos Ramirez orchestrated what prosecutors call the largest health-care fraud by one person. Over nearly four years, she electronically submitted more than 140,000 Medicare claims for unnecessary equipment and services. She used the proceeds to finance big-ticket purchases, including two condominiums and a Mercedes-Benz....

Employees review fewer than 5 percent of the nearly 1 billion claims filed each year. The vast majority of claims shuttle through computer systems that are tweaked when authorities notice fraud patterns.

And how do the Medicare and Medicaid authorities respond to these crooks?

This year, [Centers for Medicare & Medicaid Services] is working to finalize a rule that would prevent convicted felons from obtaining Medicare billing numbers.

Looks like even a universal program would leave a few people high and dry.

Senior Editor Jacob Sullum with more Medicare madness. Senior Editor Radley Balko on Medicaid Fraud and the 4th Amendment.

 

Comments

|6.13.08 @ 11:02AM|#

When the government is passing out checks, people will lie to get them. When the bureaucrats are dispensing other peoples money, they don't really care. I;m sure it's easier to pay a claim than initiate an investigation.

A reasonably smart sixth grader could easily surmise that.

Episiarch|6.13.08 @ 11:04AM|#

When the bureaucrats are dispensing other peoples money, they don't really care

Don't forget the "no consequences for losing that money" part.

Guy Montag|6.13.08 @ 11:16AM|#

At least she bought a decent car.

It could have been worse if she had used the money to get one of those government discount hybrids!

|6.13.08 @ 11:23AM|#

At least the people who should have been monitoring, but allowed such an egregious fraud to persist will be disciplined and probably fired for incompetence, right?


right?

|6.13.08 @ 11:24AM|#

Oh right
like there's nothing else incredibly lucrative about Medicare

|6.13.08 @ 11:39AM|#

As someone normally sympathetic to small or non governmental solutions, I have to say this is a pretty lame way to make the case against government health care. Are you suggesting there is no fraud in the private sector? Hello?

And along those lines, one has to keep in mind that at some point, the costs of preventing fraud or abuse will outweigh the costs of allowing some fraud and abuse. It sucks, but there you go.

People\'s Front of Judea|6.13.08 @ 11:42AM|#

Jammer, I'm not forced to pay for the fraud that occurs in the private sector.

|6.13.08 @ 11:45AM|#

Anyone have any numbers on private insurance fraud vs. Medicare fraud?

Mike Laursen|6.13.08 @ 11:48AM|#

People's Front of Judea, Jammer wasn't saying that it wasn't an argument. He was saying it wasn't a very good argument if you are trying to make the case against government health care. As in, it's unlikely to convince anybody of a liberal persuasion to change their minds.

classwarrior|6.13.08 @ 11:49AM|#

Actually People's Front you do pay for private sector fraud through generally higher prices through the fraud itself or administrative costs to prevent it. This all depends on the way a health care system is designed. With our single payer system in Canada, fraud is almost unheard of.

Guy Montag|6.13.08 @ 11:54AM|#

private insurance

LOL! That phrase is a joke right?

The only thing "private" about some insurance in the USA is that government employees are not sitting in the offices. Government employees are fluttering all over them telling what to do, who to insure, who to pay, what their rates shall be, etc., etc., etc.

If you want a study in modern National Socialism, his would be it.

People\'s Front of Judea|6.13.08 @ 11:56AM|#

Mike- alright, that makes sense.
Classwarrior- I said I'm not FORCED to pay for it. If the fraud drives prices up too much, I can stop buying. If fraud in UHC drives my taxes up too much, I have no such option.

Guy Montag|6.13.08 @ 11:58AM|#

People's Front of Judea,

The Judean People's Front is fighting to make taxes voluntary and reports great progress in the new Congress on that front.

TallDave|6.13.08 @ 11:58AM|#

This year, [Centers for Medicare & Medicaid Services] is working to finalize a rule that would prevent convicted felons from obtaining Medicare billing numbers.

You can't do that. Health care is a human right now, remember? I predict this will also be called racist.

With our single payer system in Canada, fraud is almost unheard of.

Riiiiight.

Canada's health care system is rife with fraud that costs the public and private sectors an estimated $3-billion to $10-billion a year, the country's first-ever survey of health fraud indicates

http://nalert.blogspot.com/2005/09/canadian-health-care-fraud-rampant.html

|6.13.08 @ 11:59AM|#

Besides which, the profit motive provides an incentive for providers to curtail fraud, while publicly administrated programs have no threshold for intolerable abuse.

Episiarch|6.13.08 @ 11:59AM|#

With our single payer system in Canada, fraud is almost unheard of.

So is prompt service.

M\'|6.13.08 @ 12:01PM|#

Most of the medicare fraud is committed by the doctors overbilling anyway. This is also true of private health insurance.

People\'s Front of Judea|6.13.08 @ 12:01PM|#

Guy- The only people I hate more than the Romans is the Judean's People Front. SPLITTERS!

TallDave|6.13.08 @ 12:03PM|#

Sure, but private insurers have a profit motive to prevent fraud.

Gov't employees' only motivation is to get the damned thing paid so they can go on their federal union-mandated 2-hour break.

M\'|6.13.08 @ 12:07PM|#

I also don't find it surprising that someone with an hispanic name is being used as an example.

TallDave|6.13.08 @ 12:14PM|#

I predict this will also be called racist.
...
I also don't find it surprising that someone with an hispanic name is being used as an example.

DING DING DING!! We have a winner!

|6.13.08 @ 12:15PM|#

Mike Laursen:As in, it's unlikely to convince anybody of a liberal persuasion to change their minds.

I doubt it would sway moderates, either. The cost of fraud is built in to the prices of everything we buy, insurance, eggs, news cars, etc.

Hugh Akston:Besides which, the profit motive provides an incentive for providers to curtail fraud, while publicly administrated programs have no threshold for intolerable abuse.

Yeah, and private auditors have no reason to either ignore or pump up actual fraud in order to get promotions or bonuses. Snort. Really, I'm not sure there is much difference in administering these sorts of things. Its all going to be in how you set up the incentive structure for the auditing.

The profit motive is great, but it ain't perfect.

|6.13.08 @ 12:16PM|#

M'

You must be lost, the Daily Kos is down the hall to the left. The race card is much more effective there.

Guy Montag|6.13.08 @ 12:21PM|#

The only people I hate more than the Romans is the Judean's People Front. SPLITTERS!

Perhaps the Illinois Nazis ill take up the challenge.

|6.13.08 @ 12:28PM|#

threadjack: sorta applicable

http://www.foxnews.com/story/0,2933,366501,00.html

M\'|6.13.08 @ 12:37PM|#

Tall Dave, Hugh Atkinson,

It's not the race card since I didn't claim that to be the motive but it fits "the model" so well somehow. Being accused of such was no surprise either.

TallDave|6.13.08 @ 12:46PM|#

On June 15, Jones felt light-headed and experienced heavy bleeding so her boyfriend took her to Southmead Hospital in Bristol, England for a scan. She was told the scan was "normal," the report said.

Dr. Lucy Jackson, who treated Jones, told the inquest that doctors initially failed to diagnose the condition because "the hospital was extremely busy" the night the teen checked in.

The MRI was booked, so they used an Etch-a-Sketch instead.

kinnath|6.13.08 @ 12:48PM|#

The only thing the federal government does remotely well is drop ordinance in far away lands.

|6.13.08 @ 1:02PM|#

M'

I'm not surprised you failed to spell my name right. It's so like people like you. It just fits the model so well.

For One Night Only|6.13.08 @ 1:05PM|#

The only thing the federal government does remotely well is drop ordinance in far away lands.

Akbar: "Look, that American plane just dropped something!"

Mustafa: "What is it?"

Akbar: "It's a piece of paper. It says, 'All dogs must be kept on leash at all times.' WTF?"

|6.13.08 @ 1:09PM|#

I also don't find it surprising that someone with an hispanic name is being used as an example.

Well this story wasn't about your typical Medicare fraud. It's about "the largest health-care fraud by one person," which implies a specific person (who, in this case, happened to be Hispanic).

Should they have changed her name so as not to offend anyone?

M\'|6.13.08 @ 1:19PM|#

Hugh ,

Crummy typing skillz. My fingers substitute words automatically at times. Apologies.

However I didn't know this was about my ability to be a secretary. Since you're so focused on that I know you couldn't possibly have the slightest handle on people like me. Feel free to give a profile if you like. Since I'm sure of my inner character, whatever you have to say is fine. I'll drop out of this nonsense now.

|6.13.08 @ 1:21PM|#

brotherben,

By retaining products of conception, a woman can have significant bleeding, shock and death

Eeewwwwww

M\'|6.13.08 @ 1:22PM|#

It's about "the largest health-care fraud by one person,"

Well, the largest health-care fraud by one person that they decided to investigate and/or make into news.

Naga Sadow|6.13.08 @ 2:05PM|#

I thought we already had universal healthcare?
I've had three emergency room visits and I've never had to pay a dime. Plus medical bills don't affect your chances for a loan. Good times.

Mike Laursen|6.13.08 @ 3:12PM|#

True. We do pretty much have universal emergency healthcare, although it's a bit of an ad hoc system. And we have other aspects of universal health care, at least for elderly people.

|6.13.08 @ 4:48PM|#

"'This year, [Centers for Medicare & Medicaid Services] is working to finalize a rule that would prevent convicted felons from obtaining Medicare billing numbers.'

"Looks like even a universal program would leave a few people high and dry."

A growing number and a growing percentage, to judge from out scandalous incarceration rates.

The authorities already seem eager to make drug busts that will net them proceeds from asset forfeiture. Is it possible that, some day, under a "universal" health care plan, the police will be instructed to bust as many as possible on felony charges so as to reduce the eligibility rolls for some or all of the "free" healthcare? You'd think not, but I have seen many once "unthinkable" things come to pass, so I'm not so sure.

stonebluff|6.19.08 @ 6:16PM|#

I reported to Medicare what I thought to be an egregious overcharge by a doctor after a stay in the hospital. I was told by the nice lady at Medicare. "You're wasting your time."