Posted on 09/26/2011 3:32:58 PM PDT by MindBender26
A frail but feisty, partially paralyzed wheelchair-bound Vietnam vet scored a $15 million whistelblower’s reward after uncovering a massive Medicaid fraud scheme -- with the help of his trusty calculator.
“From my wheelchair, on a ventilator and oxygen, I have spent the last seven years in this fight. Sometimes, the good guy wins,’’ said plucky Richard West, 63, of Tuckerton, NJ.
The savvy senior said he first smelled a rat when he went to the dentist in 2004 -- and was told his Medicaid benefits had maxed out.
West returned home and scoured his own, meticulously kept records, discovering that Maxim Healthcare -- the agency that provides his home-health aides -- had billed Uncle Sam for care he never got, including coverage by nurses he’d never met.
Maxim -- which has 300 offices in 40 states, including New York -- was eventually busted for netting a total of $61 million in phony reimbursements.
Under terms of a deal unveiled this week, Maxim, which is partly owned by Baltimore Ravens owner Stephen Bisciotti, agreed to fork over $121.5 million in reimbursements and penalties for the phony Medicaid claims and another $8.4 million to the Veterans Administration.
The Maryland-based company was also slapped with a $20 million fine. The feds added that they will be overseeing its operations for two years.
Under federal law, Richard West was entitled to a percentage of the payback the company was ordered to fork over.
Of his newfound millions, the disabled vet, who’s on a portable ventilator, said he plans to spend it wisely.
“I need a new van, my house needs work, and I’m going to make donations to charities for the disabled,” West said.
Maxim CEO Brad Bennett was contrite in a statement, saying: “We take full responsibility for these events.”
Read more: http://www.nypost.com/p/news/local/whi_tleblower_OtagWuaoKWNaDdMJLqA2vJ#ixzz1Z6HJ8A77
(Excerpt) Read more at nypost.com ...
Also, Why isn't Florida Gov Scott in jail? His company paid a $1.7 BILLION fine in Medicare/Medicaid Fraud claims.
Good on him but Obamacare will eliminate all waste, fraud and abuse thus delivering a substantial cost savings.
Roll on the statist utopia!
Maxim CEO Brad Bennett was contrite in a statement, saying: “We take full responsibility for these events.”
translation:
I have a plea agreement already set with the DA.
Maybe because they find a kindred sprint in those perpetuating this type of fraud and theft.
I’m glad to see that the Nam Vet did the right thing.
But I doubt that he will see any money if Obama has anything to say about it.
They're protected by the Constitution's Important People Clause.
That's a good one.
I did the right thing once and turned my Mom’s doctor in for fraud. She was on Medicare and instead of charging her the co-pay he was billing her for the difference between what he charged and Medicare paid.
I told her what he was doing was illegal and if he was doing it to her he was probably doing the same with his other Medicare patients.
I called Medicare and gave them all the info. He is still practicing and I never heard a word from them.
Maybe key people are getting a cut.
Capital punishment for such swindles would reduce the fraud.
I reported false charges by HealthSouth to my insurance company, BCBS, and they said they would pay whatever was billed and was not interested on the over-billing fraud.
Excuse me if I'm wrong but Mededicare Part B pays 80% of the office visit charges, not a set co-pay. If the office visit charge is $100 then Med-B pays $80...........and your mom pays the remaining $20. If the office visit charge is $200 then Med-B pays $160 and your mom pays the remaining $40.
Assuming you are correct, what is your mom's medicare co-pay each time she visits the doctor?
This was about 9 years ago so I may have confused co-pay with the 80% but whatever it was I figured it up and he was wrong on the way he was billing. The person I spoke to at Social Security told me he should not be billing the way he did. Nothing ever happened as far as I know.
Good because nothing should have happened.......
Having been a benefits rep. for my corporation for over 30 years, my experience has been that over 90% of the health care problems claimed by our employees and retirees have been due to the ignorance of our plan coverage by said individuals. The other 10% of the problems occured in either the doctors office in the way they submitted the claim or with our health insurance providers in the way they interpreted the claim being submitted.
Keep in mind that your doctor's #1 priority is seeing to the welfare of his patients, he/she is not involved in the billing process...........So to make a claim that "your doctor" was at fault, is erroneous...........
And because of the frequency of this misinformation, the doctor, his medical group and office staff suffer for it. And due to the increased cost involved, the investors in the insurance companies ultimately foot the bill............YOU and ME.
Oh pooh, you know nothing about this doctor. It was a single office doctor and all the billing came off a computer straight out of his office. Yes, there are still doctors like that out there.
He had total control over how billing was done.
So, your assumption that it was more a corporate thing is dead wrong.
I also stated that I had talked to the Medicare fraud people and they told me he was billing wrong based on what I told them and had me mail in copies of the bills.
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