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‘Let the Crime Spree Begin’: How Fraud Flourishes in Medicare’s Drug Plan ^ | 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.


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 ...

TOPICS: Crime/Corruption; Front Page News; Government; Politics/Elections
KEYWORDS: medicare; medicaredrugs
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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 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.



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."


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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