Fraud cases range from the sublime to the ridiculous
American investigators didn't have to look far to find examples of Medicare and Medicaid fraud.
Consider the van service that, over 16 months, billed Medicare $62 000 for ambulance trips to transport one beneficiary 240 times. Nobody noticed.
Medicare was also charged rates as high as $600 per hour for physical and speech therapy services rendered by therapists earning $20 an hour. Elderly residents of a nursing home were occasionally invited to coffee meetings to greet newcomers. When one of the resident's sons examined billing statements for his mother, he found that the nursing home had been billing Medicare for group-therapy sessions for everyone attending the coffee klatches. Nobody but the son noticed.
Dr. Barry Feldman, a podiatrist and middleman for a medical-equipment company, was convicted of soliciting Medicare referrals and then giving each patient a lymphedema pump, regardless of need. Medicare paid the $4800 bill that came with each pump.
One psychiatrist billed Medicare for an average of 26 sessions, 45-50 minutes each, per day. They had not been provided.
Then there were Robert and Margie Mills, owners of ABC Home Health Care (America's largest privately held home health-services company), who charged Medicare $84 341 for gourmet popcorn for parties and "conferences," $27 930 for ABC umbrellas, and over $1 million for liquor, lease payments for their son's BMW, maid services and utility fees for their personal ocean-front condo. In all, ABC was charged with submitting $14 million in improper billings. At the end of 1994, ABC's revenues from Medicare totalled almost $616 million for the year and accounted for 95% of the company's business. Robert Mills was subsequently convicted of Medicare fraud, mail fraud, money laundering, conspiracy and witness tampering; his wife was found guilty of making false statements.
Even mainstream hospitals have been targeted by federal investigators. Investigators say that more than 4600 hospitals have illegally billed Medicare separately for outpatient services that should have been covered by inpatient reimbursements. That's double billing, and the government says it intends to recover at least $125 million from the errant hospitals under a settlement plan that cuts their penalties in return for cooperation.
