The U.S. Department of Justice says that Medicare fraud is on the rise in Michigan and one particular area of concern is physician house calls. Years ago, doctors routinely made house calls. Now many physicians are employed by hospital owned medical groups or clinics. Finding a doctor willing to make a house call has been tough in recent decades but that trend is starting to change. The Centers for Medicare and Medicaid Services say that Medicare spending on physician house calls has increased by 40% over the last 6 years.
While overall Medicare spending for house calls is still relatively low, the numbers have been growing each year and so has fraud. USA Today quotes U.S. Assistant Attorney General Leslie Caldwell as saying, “It’s bad. And it’s just an easier thing to do in Michigan than in other states.” Almost 20% of all Medicare spending for house calls occurs in Michigan.
As our population ages, more house calls are expected. Visiting a patient at home in many cases lowers health care costs as home visits are much less expensive than hospital stays. Patients appreciate it too. Unfortunately a few unscrupulous providers have found a new way of making a fast buck. The Justice Department claims that in recent years 14 physicians have been indicted in Michigan for Medicare fraud related to house calls.
Why such so much Medicare fraud in Michigan? Prosecutors say the state is just one of five that doesn’t regulate home health care. To obtain reimbursement for home healthcare under federal Medicare regulations, however, a doctor must certify a patient’s need for home care. A booming new cottage industry was created by shady doctors who make these need determinations and shady home health care agencies that bill Medicare for services never provided or are provided by unlicensed or unqualified providers.
The victims in these scams? Patients and taxpayers, of course. Because Medicare is a federally funded healthcare program, providers that rip off the Medicare system are really ripping off the public.
Senior citizens and other home bound patients are also put at risk. While some Medicare fraud scams involve billing for services never performed, other providers subject patients to unnecessary treatments or medications. Since the medical services are provided in the home, there is little oversight and that makes it much easier to conceal the scam.
Many doctors still won’t make house calls, especially for Medicare patients. The reimbursement rates are low and the government does not pay for travel time. That means a doctor can literally see a dozen patients in the time it takes to drive even a few miles to see just one patient.
While clearly concerned about the huge surge in Medicare fraud tied to house calls, Medicare officials are testing a pilot project that allows doctors to get paid more if they can show the number of hospitalizations associated with their patients decreases.
Medicare fraud is a huge problem in the United States and not just in Michigan. Miami, Philadelphia, Ft. Lauderdale, Dallas and Houston have also seen big spikes in fraudulent claims for reimbursement. The federal False Claims Act allows insiders with original source knowledge about fraud involving government programs – whistleblowers – to receive a portion of whatever monies the government collects from wrongdoers.
This year the government paid $435,000,000.00 in whistleblower awards. Medical billing clerks and honest physicians are often the best whistleblowers.
Think you have inside information about Medicare fraud? Having a good whistleblower lawyer is important. To be eligible for a cash award, one must have inside information about a fraud against the government or a government funded program. The next step involves filing a sealed lawsuit in federal court. The government is then afforded an opportunity to investigate the claims.
Need more information? Contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). All inquiries kept in complete confidence and protected by the attorney – client privilege.