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‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan
valuewalk.com ^ | Dec 19, 2013 | by Tracy Weber and Charles Ornstein ProPublica

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 Medicare’s 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 Bagner’s 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 there’s just one problem with this accounting: The prescriptions aren’t 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 he’d never seen. Whoever did it, he’s been told, likely pilfered those drugs and resold them.

-snip-

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 ...


TOPICS: Crime/Corruption; Front Page News; Government; Politics/Elections
KEYWORDS: medicare; medicaredrugs
A good read, but very depressing. Shows why a lot of these foreign doctors accept medicare patients - wait til all the medicaid patients enter the system... like I said, very depressing knowing our leader won't enforce laws ...
1 posted on 12/21/2013 5:10:30 PM PST by 11th_VA
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To: 11th_VA

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.


2 posted on 12/21/2013 5:21:53 PM PST by cherokee1 (skip the names---just kick the buttz)
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To: cherokee1

Shrink-on-the-mall?

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.


3 posted on 12/21/2013 5:34:12 PM PST by HiTech RedNeck (The Lion of Judah will roar again if you give him a big hug and a cheer and mean it. See my page.)
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To: 11th_VA
Whoever did it, he’s been told, likely pilfered those drugs and resold them.

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.

4 posted on 12/21/2013 5:35:49 PM PST by Veto! (Opinions freely dispensed as advice)
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To: 11th_VA
Bush's fault.
5 posted on 12/21/2013 5:36:08 PM PST by Carry_Okie (0-Care IS Medicaid; they'll pull a sheet over your head and take everything you own to pay for it.)
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To: cherokee1

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.


6 posted on 12/21/2013 5:36:20 PM PST by HiTech RedNeck (The Lion of Judah will roar again if you give him a big hug and a cheer and mean it. See my page.)
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To: 11th_VA

Isn’t this one of the GWB programs supported by Obama and favored as well by Jebbie?


7 posted on 12/21/2013 5:38:46 PM PST by Theodore R. (The grand pooh-bahs are flirting with Christie, but it's Jebbie's turn!" to LOSE!)
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To: Veto!

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.


8 posted on 12/21/2013 5:39:11 PM PST by HiTech RedNeck (The Lion of Judah will roar again if you give him a big hug and a cheer and mean it. See my page.)
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To: HiTech RedNeck

She’s selling it to a crooked DRUG STORE. Clearly illegal.


9 posted on 12/21/2013 5:44:33 PM PST by Veto! (Opinions freely dispensed as advice)
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To: Veto!

Call the pharmacy board in the state.


10 posted on 12/21/2013 5:54:19 PM PST by kcvl
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Comment #11 Removed by Moderator

To: Veto!

Hmm, Generic is only $1.65 per 200mg pill. Perhaps you should ask your physician for a prescription and go see.


12 posted on 12/21/2013 6:18:44 PM PST by Usagi_yo
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To: Carry_Okie
Bush's fault.

LOL !!! Even a broken clock is right twice a day !!!

13 posted on 12/21/2013 6:24:09 PM PST by 11th_VA (I want a president who won't enforce tax laws ...)
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To: 11th_VA

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.


14 posted on 12/21/2013 6:25:41 PM PST by Chewbarkah
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To: Chewbarkah
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?

I would bet that every insurance company selling healthcare coverage already uses such software. In fact, it's probably available off-the-shelf.

15 posted on 12/21/2013 6:33:54 PM PST by Carry_Okie (0-Care IS Medicaid; they'll pull a sheet over your head and take everything you own to pay for it.)
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To: grumpygresh
I am so glad that I don’t take crapping Medicare anymore.

Did you opt out? Did you find something else to take its place?

16 posted on 12/21/2013 6:52:04 PM PST by upchuck (My Internet addiction is so bad... it's alt of ctrl.)
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To: Chewbarkah
Every senior who has Medicare Drug Coverage is paying out the nose in higher premiums because of gross, intentional corruption.

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.

17 posted on 12/21/2013 6:57:17 PM PST by upchuck (My Internet addiction is so bad... it's alt of ctrl.)
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To: Chewbarkah

“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.


18 posted on 12/21/2013 9:16:37 PM PST by headstamp 2 (What would Scooby do?)
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To: upchuck

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.


19 posted on 12/22/2013 6:27:58 AM PST by Chewbarkah
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To: Carry_Okie

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.


20 posted on 12/22/2013 6:45:27 AM PST by Chewbarkah
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To: Carry_Okie

For once it really is Bush’s fault.


21 posted on 12/22/2013 8:17:30 AM PST by P-Marlowe (There can be no Victory without a fight and no battle without wounds)
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To: Veto!
She's an upstanding church member.

Sure sounds like it.

22 posted on 12/22/2013 9:03:30 AM PST by unixfox (Abolish Slavery, Repeal the 16th Amendment)
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To: Chewbarkah
$500-$600 per month for their Medicare drug coverage

That's very possible.

Understand that I'm on the very low end of needing Rx drugs.

Those that have serious medical conditions will have to pay much more.

But, truth be told, there are government programs people in that situation can tap.

23 posted on 12/22/2013 11:47:12 AM PST by upchuck (My Internet addiction is so bad... it's alt of ctrl.)
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To: Veto!
A $6,000/month resalable prescription can be yours.

The real crime is the $6,000.00 price tag.

24 posted on 12/22/2013 4:05:06 PM PST by itsahoot (It is not so much that history repeats, but that human nature does not change.)
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To: Carry_Okie
Bush's fault

You got that right. Instead of working to rein in abuse of federal drug subsidies, he got the pharmaceutical program for Medicare patients.

If people had to pay for their medications, the abuse problems would disappear. If the problem is medications they can't afford, in a free market system (1) prices would come down and (2) cheaper alternatives would emerge.

25 posted on 12/22/2013 4:12:31 PM PST by grania
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To: Veto!

You need to call the Medicare Fraud line and report this lady, the pharmacy, the doctor, give them the name of the drug. I work at a hospital and if I wanted, could access Provider ID’s just like that...but, I am honest person.

It burns my bum all the fraud going on and when folks try to report it nothing ever gets done about it all.

Billions of dollars wasted. I wish Government would hire more auditors, just such a waste.


26 posted on 12/23/2013 12:48:25 PM PST by Engedi
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To: Engedi

The police have a full report and the pills. It was last summer, I’m not sure what they did with them.

I’m deeply offended by this hypocritical sanctimonious woman, by the extraordinary price for this drug that does very little that coffee can’t do, by blatant drug selling in this town, which the police just yawn at.

On another occasion, my friend who is an addictions counselor and knows an addict and drug deal when he sees one, went with me to report blatant meth sales in our neighborhood, the cops just LAUGHED and said, “Good luck with that.” They do nothing unless people are cooking meth and blowing up buildings, and then they arrive after the fact.

We’re really on our own. in this charming REPUBLICAN city.


27 posted on 12/23/2013 5:46:05 PM PST by Veto! (Opinions freely dispensed as advice)
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To: All
Below is just a scintilla of the massive multi-billion healthcare fraud in existing programs......sap-happy O/Care's got huge pots of money and very little oversight...ready and waiting for fraudsters.

============================================

Medicare paid millions to illegal immigrants, dead patients, probe finds
By Stephen Dinan / The Washington Times

Medicare paid $23 million for dead patients in 2011 and $29 million for drug benefits for illegal immigrants from 2009 to 2011, according to a report Thursday from the Health and Human Services inspector general.

The investigators said Medicare has safeguards to try to stop payments to dead patients, but it still ended up sending out the $23 million anyway.

The Centers for Medicare and Medicaid Services (CMS) — the same agency that is struggling to fix the broken Obamacare website — acknowledged the problems and said it will try to take steps to fix them.

“We agree that in cases where the information indicates an individual is not lawfully present in the United States, that individual should not be permitted to enroll or to remain enrolled in a Part D plan during the period where he or she is not eligible to receive federal benefits,” Marilyn Tavenner, administrator of CMS, said in response to the report about illegal immigrants getting benefits.

The payouts aren’t large — they amount to just a fraction of a percent of what Medicare pays each year in benefits. Still, the investigators said the agency should take steps to crack down.

In one of its reports the inspector general said 4,139 illegal immigrants were able to make 279,056 drug benefit claims.

The investigators said that while CMS has policies to prevent illegal immigrants from getting most Medicare benefits, it didn’t have such a policy for the prescription drug program, which was added under President George W. Bush and expanded by President Obama’s health law.

As for dead patients collecting benefits, the investigators said the problems were often related to missing or incorrect dates of death.

Dead doctors also were paid $25 million over a three-year period.

Sen. Tom Coburn, Oklahoma Republican (a doctor), said the report was worrying because CMS had been warned of the problems five years earlier.“Every individual wrongfully awarded benefits, be it the deceased or undocumented, diverts scarce resources away from those who need it most,” he said.

SOURCE http://www.washingtontimes.com/news/2013/oct/31/medicare-paid-millions-dead-patients-illegals/#ixzz2jK6Gu1dx

========================================

NOTE 4,139 illegal immigrants were able to make 279,056 drug benefit claims............................ That’s 67 per immigrant. Are they selling these drugs? Is that where the brand new Escalades are coming from...being driven w/out valid licenses?

28 posted on 12/28/2013 1:39:30 PM PST by Liz
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To: All
NY POST EXCERPT--- Mexican cartels dispatch agents deep inside US - spread into non-border states

CHICAGO (AP) — Mexican drug cartels whose operatives once rarely ventured beyond the US border are dispatching some of their most trusted agents to live and work deep inside the United States — an emboldened presence that experts believe is meant to tighten their grip on the world's most lucrative narcotics market and maximize profits. If left unchecked, authorities say, the cartels' move into the American interior could render the syndicates harder than ever to dislodge and pave the way for them to expand into other criminal enterprises such as prostitution, kidnapping-and-extortion rackets and money laundering.

Some cartels even have Mexican operatives fill out job applications before being dispatched to the US, Riley added.

In Mexico, the cartels are known for a staggering number of killings — more than 50,000, according to one tally. Beheadings are sometimes a signature. So far, cartels don't appear to be directly responsible for large numbers of slayings in the United States, though the Texas Department of Public Safety reported 22 killings and five kidnappings in Texas at the hands of Mexican cartels from 2010 through mid- 2011. Still, police worry that increased cartel activity could fuel heightened violence.--SNIP--

In Chicago, the police commander who oversees narcotics investigations, James O'Grady, said street-gang disputes over turf account for most of the city's uptick in murders last year, when slayings topped 500 for the first time since 2008.

Although the cartels aren't dictating the territorial wars, they are the source of drugs. Riley's assessment is stark: He argues that the cartels should be seen as an underlying cause of Chicago's disturbingly high murder rate. "They are the puppeteers," he said. "Maybe the shooter didn't know and maybe the victim didn't know that. But if you follow it down the line, the cartels are ultimately responsible."

SOURCE http://www.nypost.com/p/news/national/mexican_cartels_dispatch_agents_ZsKwR5wQCvQvpBXnejs1TJ

29 posted on 12/28/2013 1:43:21 PM PST by Liz
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To: 11th_VA
A physician friend had the same experience. After a short period of work at a MediCal clinic, he noticed they'd retained his ID and were filing claims in his name. He immediately notified the state, got no reply, then spent three years writing, calling, and visiting trying to get them to listen to him. When they finally discovered the fraud, they tried to blame it on him, and he and his lawyer spent two more years getting it straightened out. He'd maintained copies of his correspondence with the state, but they'd somehow “accidentally lost it”.
30 posted on 12/28/2013 11:34:44 PM PST by ArmstedFragg (hoaxy dopey changey)
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To: Chewbarkah

If they stopped fraud, they wouldn’t be able to justify additional entitlement programs by promising they’d offset them by eliminating fraud. In my old neighborhood, MediCal and Medicare fraud were cottage industries, operated by primarily by folks of various eastern European ethnicities.

I once met a guy who had a job at a medical equipment store where his job consisted entirely of telling anyone who walked in and wanted to buy or rent something that they were currently out of that item. The place was just a front for fraudsters. Over a period of a couple of years it changed locations and names several times.

He had an awkward experience the first few days on the job when he tried to rent the wheelchair to someone and the boss went ballistic. He’d almost blown the whole setting.


31 posted on 12/28/2013 11:56:20 PM PST by ArmstedFragg (hoaxy dopey changey)
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