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.
For once it really is Bush’s fault.
Sure sounds like it.
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.
The real crime is the $6,000.00 price tag.
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.
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.
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.
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 arent 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 didnt have such a policy for the prescription drug program, which was added under President George W. Bush and expanded by President Obamas 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............................ Thats 67 per immigrant. Are they selling these drugs? Is that where the brand new Escalades are coming from...being driven w/out valid licenses?
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."
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.