OT - Fake DMEs steal billions from medicare

I saw this on ABC world news last night:
http://abcnews.go.com/Video/playerIndex?id=7522333


Yikes.

This is our money!

.
WOWSY!!! JUST GLAD IT IS OUT IN THE OPEN NOW . . . IT'S PROBABLY EVEN BIGGER THAN THEY KNOW NOW!

I'm sure Obama will jump right on this in his efforts to uncover cutbacks and unnecessary spending!

.... and then there are the billions they steal from private insurance. The US health care system is broke because there is not enough government involvement, unlike what conservatives would have you believe. I heard on NPR this morning that the private insurance industry is actually lobbying congress for MORE health care regulation in order to trim their losses and level the playing field.

All I got at that URL was a SLOW loading video of a Claritin commercial. I guess as more and more newspapers and news magazines die I'll be forced back to TV network news for my news sources. What a sad state of affairs. So far I've been lucky to find a couple of news sites on the net that rely on text ..... *sigh*

DreamStalker wrote:.... The US health care system is broke because there is not enough government involvement, unlike what conservatives would have you believe.

If this statement is wholly true, is CPAP.com also part of the problem? Would regulating it increase or decrease its effectiveness?

Also, pardon the conservative/libertarian irrational overstep of an innocently made point, but if that line of reasoning holds, shouldn't CPAPtalk be regulated as other discussion forums are? Would that increase or decrease its effectiveness?

More Thoughts:

1. Here's one that'll knock your socks off, I am on the DMEs side on this issue. Though I have no love for the great majority of them or what they do to people, I am on the front lines and believe I have a good vantage point to determine truth on this issue. They are regulated into the ground and more is coming. They are so completely and totally controlled by rules that they couldn't offer good service and care if they wanted to. They are so covered up by rules (not laws mind you, that is another separate layer of devastation) that they hire people to keep account of them all and they can not. The government who imposes them doesn't even know where they are all or how to find and reference them. Those DMEs who provide good care anyway are at risk legally and penalized financially.

What you will see in the coming years is the government levying additional taxes on businesses in our industry through the use of "DME Violations". They will point somewhere in their book, call you guilty, order you to pay. You have not innocent until proven guilty and they take your money or freeze your money BEFORE you can get a hearing to determine innocence. They are truly extra-constitutional in this regard. The DMEs have major issues and have done harm, but they are amateurs compared to the damage government involvement has brought and is ramping up to bring.

2. We call BCBS, Aetna, Cigna, etc "private" insurance companies as if they are really the free market. Then conservatives get to choose between backing them on free market grounds or going over the the other side of the aisle. I do neither. Our private insurance companies are not operating in a free market, they have it locked down, regulated and monopolized. They pay what they want, when they want, to who they want. They adopt the rules from the government that please them and add others that benefit them. They are the customer of the "providers" instead of the end user. It is inaccurate to call these perversions private companies or their sector a free market. They are a trust that needs to be busted in the name and interest of a real free market. Instead, we'll call them evil and lobby to replace them with a greater evil.

Johnny

Other countries that are successfully providing health care thru insurance have NOT FOR PROFIT insurance and it works. When I was a kid BCBS was not profit insurance. Why would anybody defend companies that have become thieves? They want your money but then try to get out of paying for what you pay premiums for. Don't believe me? Take the three hour Katrina tour in New Orleans.

johnnygoodman wrote:

DreamStalker wrote:.... The US health care system is broke because there is not enough government involvement, unlike what conservatives would have you believe.

If this statement is wholly true, is CPAP.com also part of the problem? Would regulating it increase or decrease its effectiveness?

Also, pardon the conservative/libertarian irrational overstep of an innocently made point, but if that line of reasoning holds, shouldn't CPAPtalk be regulated as other discussion forums are? Would that increase or decrease its effectiveness?

More Thoughts:

1. Here's one that'll knock your socks off, I am on the DMEs side on this issue. Though I have no love for the great majority of them or what they do to people, I am on the front lines and believe I have a good vantage point to determine truth on this issue. They are regulated into the ground and more is coming. They are so completely and totally controlled by rules that they couldn't offer good service and care if they wanted to. They are so covered up by rules (not laws mind you, that is another separate layer of devastation) that they hire people to keep account of them all and they can not. The government who imposes them doesn't even know where they are all or how to find and reference them. Those DMEs who provide good care anyway are at risk legally and penalized financially.

What you will see in the coming years is the government levying additional taxes on businesses in our industry through the use of "DME Violations". They will point somewhere in their book, call you guilty, order you to pay. You have not innocent until proven guilty and they take your money or freeze your money BEFORE you can get a hearing to determine innocence. They are truly extra-constitutional in this regard. The DMEs have major issues and have done harm, but they are amateurs compared to the damage government involvement has brought and is ramping up to bring.

2. We call BCBS, Aetna, Cigna, etc "private" insurance companies as if they are really the free market. Then conservatives get to choose between backing them on free market grounds or going over the the other side of the aisle. I do neither. Our private insurance companies are not operating in a free market, they have it locked down, regulated and monopolized. They pay what they want, when they want, to who they want. They adopt the rules from the government that please them and add others that benefit them. They are the customer of the "providers" instead of the end user. It is inaccurate to call these perversions private companies or their sector a free market. They are a trust that needs to be busted in the name and interest of a real free market. Instead, we'll call them evil and lobby to replace them with a greater evil.

Johnny

Well I suppose I shouldn't be surprised that the private insurance industry has alterior motives behind the lobby for more government regulation (as you described in your point number one).

I agree with point 2, that certain corporate business/industries (aka monopolies) are too big to grow anymore as they are too big too fail (financial and auto industries come to mind right now for some reason) ... that is the point behind my statement for more government invlovement (I would like to see an era of big business/industries busted up into smaller ones) ... but I do see how big government can and often is used by big business to make big business even bigger and more costly to the end users ... us little guys.

BTW - I don't consider CPAP.com a "big business" corporation like Coca Cola, Exxon, McDonalds, WalMart, etc..

Johnny,

Thanks you for stating that so eloquently.

Recently we had to hire a part-time admin person just to follow up with Medicare and Medcaid patients to remind them of follow ups with their physician. I still do the clinical phone calls and folow ups, I just didn't have the time to call everyone's Dr. and get follow up notes from them, and all the other clerical work involved with Medicare and Medicaid. This was despite the fact we took an $18,000 hit in Oxygen reimbursments per month staring Jan 1st.

So more regulation, i'm with Johnny is saying no thank you.

I will also agree with him on the "private" insurance stance. I see people posting on here all the tiem about how their insuarance company is getting ripped off. Trust me your insurance company knows exactly what they are getting into, all of the prices are prenegotiated in a contract with the DME. Often this is done on a corporate level by legal teams with little to no input from clinical personell. They will pay higher amounts on some things and less on others, and they will also put high failure rate items like CPAP's on rental contracts. They do this because they are banking on the fact that you will call it quits after a few months and they are than only out a couple of hundred dollars instead of a couple of thousand. I could go on and on, but I think you see where I'm comming from.

I agree with you the American Health care system is broke, however I don't see more government regulation being the answer.


AKCPAPGUY

Oh and sorry I haven't been around much, with 3 teenagers in the house life happens.

Curious, but not willing to diddle around w/abcnews' slow loading video w/the slow speed dialup I'm stuck w/I tried a google search on "medicare fraud in Miami". Given the multiple names being indicted one can't help but wonder if many or most of these crooks aren't Castro's refugees (and/or their kids) when he emptied his prisons years ago and shipped them out on boats and we allowed them in.

Dr. Carmen Lourdes del Cueto, 65; Drs Marco Tulio Molinares, 74, and Alejandro Enrique Casuso, 73; Drs Walter Proano, 46, and Manuel Barbeite, 70; Drs Dr. Roberto Rodriguez, 54, and Dr. Carlos Garrido, 69; Esther Romeu, the owner of Diagnostic Medical Choice in Miami; medical assistants, Gonzalo Nodarse, 38, and Alexis Carrazana, 41, and a chemist, Alexis Dagnesses, 44, who worked at Midway Medical Center in Miami regarding fraudlent charges for obsolete infusion drugs for HIV patients who generally didn't need or receive the therapy.

Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.

Mabel and Abner Diaz, wife and husband, operating All-Med Billing Corp. (All-Med), a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment (DME) and related services in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient.

Amry Garcia, Davel Hernandez, and Rene Raimundo Hernandez charged with conspiring to defraud Medicare in their operation of A-1 Durable Medical Equipment and Supplies, Inc; Jose Luis Palma Jr. and Luis Gonzalez with conspiracy and Medicare fraud in connection with the operation of Simply Medical Services Inc. (Simply Medical), a Miami DME company. In addition, Gonzalez was charged with Medicare fraud in relation to another DME company, Premier Medical Service. Inc.; Jose Tomas Iglesias, Marco Antonio Marrero, and Leslie Gonzalez of Bridge Medical Equipment Inc.; Alejandro De La Victoria, the owner of Precise Medical Services Inc., Maria Oliveros-Garay of Abue Medical Equipment, Inc.,; Mario Mira of Mario & Clara Medical Supply Inc.; Eduardo Ruiz of EZ Medical Inc.

Dermatologist Ana Caos, M.D., convicted of Medicare fraud; Pedro Cuni currently serving time in prison for Medicare fraud; Orlando Pascual, another company owner who is serving time in prison for Medicare fraud; ... instead of paying to support them in our jails and prisons make we should ship them back to Castro! Heaven knows we have enough crooks of our own!!!

Slinky wrote:Curious, but not willing to diddle around w/abcnews' slow loading video w/the slow speed dialup I'm stuck w/I tried a google search on "medicare fraud in Miami". Given the multiple names being indicted one can't help but wonder if many or most of these crooks aren't Castro's refugees (and/or their kids) when he emptied his prisons years ago and shipped them out on boats and we allowed them in.

Dr. Carmen Lourdes del Cueto, 65; Drs Marco Tulio Molinares, 74, and Alejandro Enrique Casuso, 73; Drs Walter Proano, 46, and Manuel Barbeite, 70; Drs Dr. Roberto Rodriguez, 54, and Dr. Carlos Garrido, 69; Esther Romeu, the owner of Diagnostic Medical Choice in Miami; medical assistants, Gonzalo Nodarse, 38, and Alexis Carrazana, 41, and a chemist, Alexis Dagnesses, 44, who worked at Midway Medical Center in Miami regarding fraudlent charges for obsolete infusion drugs for HIV patients who generally didn't need or receive the therapy.

Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.

Mabel and Abner Diaz, wife and husband, operating All-Med Billing Corp. (All-Med), a Miami medical billing company, and executing a scheme to submit tens of millions of dollars in fraudulent claims to Medicare from 1998 to 2004 for reimbursement for durable medical equipment (DME) and related services in false claims on behalf of 29 DME companies. The claims were allegedly fraudulent in that the equipment had not been ordered by a physician and/or had never been delivered to a Medicare patient.

Amry Garcia, Davel Hernandez, and Rene Raimundo Hernandez charged with conspiring to defraud Medicare in their operation of A-1 Durable Medical Equipment and Supplies, Inc; Jose Luis Palma Jr. and Luis Gonzalez with conspiracy and Medicare fraud in connection with the operation of Simply Medical Services Inc. (Simply Medical), a Miami DME company. In addition, Gonzalez was charged with Medicare fraud in relation to another DME company, Premier Medical Service. Inc.; Jose Tomas Iglesias, Marco Antonio Marrero, and Leslie Gonzalez of Bridge Medical Equipment Inc.; Alejandro De La Victoria, the owner of Precise Medical Services Inc., Maria Oliveros-Garay of Abue Medical Equipment, Inc.,; Mario Mira of Mario & Clara Medical Supply Inc.; Eduardo Ruiz of EZ Medical Inc.

Dermatologist Ana Caos, M.D., convicted of Medicare fraud; Pedro Cuni currently serving time in prison for Medicare fraud; Orlando Pascual, another company owner who is serving time in prison for Medicare fraud; ... instead of paying to support them in our jails and prisons make we should ship them back to Castro! Heaven knows we have enough crooks of our own!!!

You are sounding a bit like Lou Dobbs there Slink ... I think you should stick to your default option and just push them all down the stairs

I'm afraid I have to start w/the big banks and fund manager CEOs and various other Wall Street sorts first, DreamStalker. As much as the Medicare frauds are costing us those Wall Street mucky-mucks cost us a h*ll of a lot more.

Slinky wrote:I'm afraid I have to start w/the big banks and fund manager CEOs and various other Wall Street sorts first, DreamStalker. As much as the Medicare frauds are costing us those Wall Street mucky-mucks cost us a h*ll of a lot more.

Oh, you mean like this guy ...

http://news.yahoo.com/s/nm/20090508/pl_ ... d_friedman

Yup, yup, he'll do. I just hope there are enough long stair wellls on Wall Street!

what medical billing do you guys use?