Skip to comments.Doctor Accused Making $800k Plus from Health Care Fraud
Posted on 02/22/2011 8:05:42 AM PST by Walts Ice Pick
The federal government is suing a local doctor to recover more than $800,000 it says he was paid after fraudulently billing Medicare and Medicaid.
In a civil complaint filed in U.S. District Court in Greenbelt, the Department of Health and Human Services says it wants to recover $814,315 that Dr. Abdul Fadul allegedly collected from the two programs through fraud.
The complaint, which also names one of his clinics, the Cardio Vascular Center in La Plata, as a defendant, says Fadul billed Medicare and Medicaid for procedures that weren't performed thousands of times between 2004 and 2005.
(Excerpt) Read more at washingtonexaminer.com ...
Annual Medicare Fraud: $60 Billion; Annual Profits of Top Ten Insurance Companies: $8 billion
By Paul Martinka
Russian poster shushed immigrant partners in Medicare fraud. Insert pic is
a Russian immigrant not too happy about being nailed for allowing doctors to
submit her Medicare account for 3,774 medical services over six years.......
for a fee.
[Annual Medicare Fraud: $60 Billion; Annual Profits of Top Ten Insurance Companies: $8 billion]
The Lord God of Israel and His Son Jesus Christ give, but democrats and liberals take away and are part of the Wicked of the earth whom the Lord Jesus will root out at His coming.
Wow, that’s truly amazing!
Dr. Abdul Fadul ?
I love it.
The government reimburses doctors (in my state) $0.14 for every dollar they charge, but the doctors are the criminals.
In related news... over the weekend I got a call from my newly-minted 65-year-old mother, who has just moved to a different town and is unable to find a doctor at any of the local practices who is taking new Medicare patients. I wonder how that could be, with our new whiz-bang National Socialist Heathcare Law?
>The government reimburses doctors (in my state) $0.14 for every dollar they charge, but the doctors are the criminals.<
Some doctors charge 25-50 K for minor treatments, like say-cortisone shots and call it surgery. Those are the doctors that are criminals.
Interesting. I think I’m going to call you out.
Any treatment by any medical professional anywhere is required to have an alphanumeric billing code on their billing correspondence. Any insurer, including the US govt, is going require proof of medical neccessity for any treatment over $5K. Moreover, a “25-30K charge for minor treatments” are going to raise a double red flag when the billing for such treatments comes from a doctor’s office.
I insure doctors. The overwhelming majority of them are on the edge of excluding all Medicare patients because they cannot afford to provide care for them, as any care given to such patients is essentially free. While I’m sure there are some docs who are crooks, it is virtually impossible for any doctor to do what you claim.
Perhaps you could provide some examples of the figures you cite.
Dr. Abdul Fadul. Hmmm, someone better compare his address book to his cancelled checks. Grab his computers and cell phones for evidence, too.
"The Only One Of Millions Who Got Caught"
Put another way, honest docs cannot afford to deal with the Medicare system and still stay in business, leaving the field to docs with "creative" billing ideas which cost the system far more money than if they had rates that honest docs could live with.
Some doctors charge $400 for a single dose bottle of grape flavored laxative that Walgreens sales for about a dollar.
It’s going beyond Medicare and Medicaid refusal.
There is a growing number of doctors who are charging a flat in-the-door rate of like 25 bucks for a visit/exam.
No insurance allowed. None.
Takes way too much time and trouble to handle the insurance end, time and trouble that can be used to focus on patients.
There’s a pediatric doctor here who makes fully insured parents fill out a medicare form before she will give their kids the prescription or shots they need. She knows that worried parents will sign anything to get immediate treatment for their kids. A parent asked for their child’s medical record to be transferred and got a copy of it. The doctor had written up that the parent unfit and was endangering the child’s life, blah, blah, just because she had asked a minor question of the doctor.
You can call me out all day.
SAYING you insure doctors and implying you have some sort of expertise in the matter is all good and fine, but you didn’t provide any proof of that before you “called me out” did you?
>While Im sure there are some docs who are crooks, it is virtually impossible for any doctor to do what you claim.<
Some doctors(or whoever is doing their billing)will lie and use different codes to describe what was actually done.
>Moreover, a 25-30K charge for minor treatments are going to raise a double red flag when the billing for such treatments comes from a doctors office.<
Sure-it should raise a red flag. Sometimes these things have to be pointed out to the insurance company and the state medical board.
>Perhaps you could provide some examples of the figures you cite.<
Unfortunately, I can’t really divulge any more details and expect to retain anonymity.
Why do you need this information so desperately?
I’ve been going to a doctor like that for several years...gives us more control over HEALTH also. (but, I don’t pay $25 (more like $300/hr) - cause I only see the doc once a year for blood work, etc.) (Worth EVERY PENNY!)
I thought that was a hospital thing.
I’ve heard that some people who are on maintenance meds can bring their meds to the hospital to avoid the outrageous charges for each pill. I tried to do something like that when hubs was in the hospital but they refused.
I can’t really blame them though. I expect they wouldn’t want any more liability issues then they already have. I was discussing crooked docs earlier, but there are also crooked patients who probably make a living out of suing people and never leave the house without a banana peel to trip on somewhere.
I would bet 90% of Doctor visits are for (relatively) minor issues.
Somebody cut themselves and needs a couple stitches. Kids with ear infections. Somebody stepped on a nail and needs a tetanus shot. Prescription refills.
If I were a doctor I would have 3 rules:
You must sign and agree to a promise you WILL NOT SUE FOR MALPRACTICE
IF I was to find something serious and recommended you go to a specialist, YOU MUST GO, or I will cease treating you.
True, the “creative billing” docs cost the system more per doctor, but are only a part of the problem. The Medicare system is losing money because of its own infrastructure, and because so much of the funding which should be allotted to it is being siphoned off for other govt overspending (with those sweet US Government IOUs left in place of real funding). The govt cannot afford to pay doctors and hospitals better rates because they have already spent the money elsewhere on things that are not claims-related.
Honest docs cannot afford to stay in business with current reimbursement rates. I know several hundred small-practice MDs and specialists, and it is a purely stop-loss business decision: cut the Medicare patients down to the smallest number possible, or go out of business.
>Honest docs cannot afford to stay in business with current reimbursement rates. I know several hundred small-practice MDs and specialists, and it is a purely stop-loss business decision: cut the Medicare patients down to the smallest number possible, or go out of business.<
That’s a real shame.
Billing and rates are so strange. When my husband was in the hospital, the cancer doc that came in and shook his hand billed more for that than the surgeon who opened up his lungs and probably saved his life so he could pursue his treatment did.
But the cancer doc is probably continuously upgrading his education and knowledge due to new innovations in treatment.
If you were really charged more for what insurers call a “Physician’s Visit While Hospital Confined” than for a surgical procedure, you should probably have your insurer look into the bill for overcharges.
Of course, if it were a bill for a visit from the Chief of Oncology versus the personal bill from a regular surgeon, that I can see (providing it was a long visit, a simple surgery, and the discrepancy was a small one). Your surgeon may have also forgone a part of his bill for services due to insurance policy restrictions or another arrangement with the insurer or the hospital.
She should be reported——big red flag for govt healthcare fraud.
>If you were really charged more for what insurers call a Physicians Visit While Hospital Confined than for a surgical procedure, you should probably have your insurer look into the bill for overcharges.<
He is the chief of oncology and all of the doctors who cared and continue to care for my husband have been phenomenal.
Thankfully, my husband is doing extremely well now.
>Your surgeon may have also forgone a part of his bill for services due to insurance policy restrictions or another arrangement with the insurer or the hospital.<
Maybe so. She is an excellent surgeon and has pioneered several new laser procedures.