Radmax receives the CMS Office of Public Affairs alerts and I was shocked when I read the Oct 4th release describing a $430 million dollar sting operation involving 91 individuals in seven states. The press release touted the success of the OIG ‘s anti-fraud battle against parties trying to plot schemes to pocket federal monies. The article is full of examples of devious practices in healthcare that undermine the integrity of our nation’s system of providing healthcare to the elderly, disabled and impoverished Americans. The schemes are so outlandish that I can’t imagine how they kept the plots under wraps without the OIG catching on sooner.
According to court documents the defendants, who served as administrators at the hospitals, paid kickbacks in the form of cigarettes, food and coupons redeemable for items available at the hospital’s “country stores” in exchange for Medicare beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP). The other schemes were to bring people in for mental health services and have them watch television, play games or maybe have lunch. The accused “healthcare providers” then would bill these activities as Medicare or Medicaid services eligible for reimbursement.
When articles like these come out and I read them, I often wonder where we are heading in the next decade in regard to ethical healthcare. Is it just that people do not care about the country’s healthcare financing deficits or have compassion for the recipients of care anymore? In listening to all accounts of CMS‘s war on increased healthcare costs I wonder how we can fix this problem. The article reminds us that all providers of healthcare are under a microscope of accountable care. With that being said, all I can do is wonder about the future healthcare of the 314 million Americans, of which approximately 47.5 million are Medicare and 42.5 million Medicaid recipients. Will it continue to be available to those who desperately need it?