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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
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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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