Skip to comments.‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan
Posted on 12/21/2013 5:10:30 PM PST by 11th_VA
With just a handful of prescriptions to his name, psychiatrist Ernest Bagner III was barely a blip in Medicares vast drug program in 2009.
But the next year he began churning them out at a furious rate. Not just the psych drugs expected in his specialty, but expensive pills for asthma and high cholesterol, heartburn and blood clots.
By the end of 2010, Medicare had paid $3.8 million for Bagners drugs 2014 one of the highest tallies in the country. His prescriptions cost the program another $2.6 million the following year, records analyzed by ProPublica show.
Bagner, 46, says theres just one problem with this accounting: The prescriptions arent his. All of that stuff you have is false, he said.
By his telling, someone stole his identity while he worked at a strip-mall clinic in Hollywood, Calif., then forged his signature on prescriptions for hundreds of Medicare patients hed never seen. Whoever did it, hes been told, likely pilfered those drugs and resold them.
Fraud rings use an ever-evolving variety of schemes to plunder the program.
In one of the most popular, elderly, broke, disgraced or foreign-trained doctors are recruited for jobs at small clinics. Their provider IDs are used to write thousands of Medicare prescriptions for patients whose identities also may have been bought or stolen. Once dispensed, the drugs are then resold, sometimes with new labels, to pharmacies or drug wholesalers.
In other schemes, investigators say, pharmacies are active participants, billing Medicare multiple times for prescriptions they never fill.
(Excerpt) Read more at valuewalk.com ...
Then you have Ol’ Ernie himself. Never had a freeekin’ clue there was a problem. NOTHING ever came to his mailbox? He never renewed his license? I say lock up Ernie too just for being a dumbass and expecting us to believe that krap.
I guess it’s possible he was a dupe. With modern equipment someone can reproduce a signature easily. And the scheme was more complex than dealing in dope which would have attracted police interest fairly quickly. This was dealing in non controlled RX’s.
I’m now in the belly of the beast. In principle the system could catch this kind of nonsense pretty quickly. In practice? Who knows.
A woman in my apartment complex resells her $6,000/month Provigil pills to a sneaky pete drugstore for $1800 cash, she told me. I took her pills and the info to the police, they could not have cared less. Prescription was written by a reputable physician in an upscale 'hood. I'm sure this goes on full-time. I happen to detest the woman, but she is educated, dresses really well, does not fit the "poor ratty looking immigrant" profile at all. She's an upstanding church member.
Provigil cures nothing; it keeps you awake. Acts on the same receptors in the brain that cocaine effects. Go tell your doctor you have narcolepsy and voila! A $6,000/month resalable prescription can be yours.
I am seriously ticked. SERIOUSLY. Next time, I'm going to DEA office and notifying Medicare Fraud.
Anyhow it looks like America at least acquiesces to this safety net if not loves it.
One could argue for a private, charity-conducted network to get this thing out of government hands. But someone is going to have to step up with a proposal, otherwise it will keep on keeping on with great momentum until something starves it.
Isn’t this one of the GWB programs supported by Obama and favored as well by Jebbie?
Many medicines are maintenance drugs not “cures” and this does not make them any less acceptable in modern medicine. If you wanted to keep only the “cures” then diabetics would be very upset, for one thing.
Anyhow, maybe she thinks she is doing her neighbor good by selling this stuff to him/her. I used this stuff briefly and it didn’t cost six grand a month.
She’s selling it to a crooked DRUG STORE. Clearly illegal.
Call the pharmacy board in the state.
Hmm, Generic is only $1.65 per 200mg pill. Perhaps you should ask your physician for a prescription and go see.
LOL !!! Even a broken clock is right twice a day !!!
Medicare has to process every bill and claim. Each prescription and service must be generated by a physician with valid and unique “provider number”. How hard would it be to use simple computer programs to monitor each “provider number” for prescription activity outside normal expectations for a given medical practice or specialty, then focus on the bad apples? The Obama administration can’t operate a lemonade stand, but this has been going on for decades. The government does not want to stop Medicare fraud, or it would. Every senior who has Medicare Drug Coverage is paying out the nose in higher premiums because of gross, intentional corruption.
I would bet that every insurance company selling healthcare coverage already uses such software. In fact, it's probably available off-the-shelf.
Did you opt out? Did you find something else to take its place?
Higher premiums? Not always. For the plan I'm on, I paid $18.50/mo in 2013. I'll be paying $12.60 in 2013 for the same plan except the deductible is lower and they lowered my co-pay on Rx drugs to a dollar.
“How hard would it be to use simple computer programs to monitor each provider number for prescription activity outside normal expectations for a given medical practice or specialty, then focus on the bad apples? “
You can bet if it was something akin to the credit card companies, they would be nailing these guys left and right.
The government is a plodding elephant. They can’t even get a website up and running after 3-4 years.
Thanks for the correction. My overgeneralizing came from the comments of elderly friends who at least say they have to pay $500-$600 per month for their Medicare drug coverage. There must be different plans and costs depending on the “tier” of drugs involved. Sounds like you have a heck of a deal.
That is my assumption also (except the software is probably all custom-written). I have tried unsuccessfully to find information about fraud costs and rates in private health insurance. If anyone knows of a source, please advise. It would seem to be a critical illustration of why government should not be in the insurance, or any, business.