We have long said that Medicare fraud hurt patients. There is the direct impact, of course. Doctors that perform unnecessary procedures are an obvious example.
For weeks, we have been covering the story of Dr. Farid Fata, the disgraced physician who prescribed powerful and dangerous cancer drugs to patients without cancer. One man lost all his teeth, others were disfigured, lost their hair or developed brittle bones. For some really sick and greedy healthcare providers, Medicare fraud is all about squeezing a few extra dollars from the government (and taxpayers who fund both Medicare and Medicaid) no matter how much their patients may suffer.
There is also an indirect effect. Healthcare resources are already spread thin, particularly in certain medical specialties. States and Congress don’t have unlimited supplies of cash. (Some folks would say that our government is technically insolvent.)
Because budgets are strapped, Medicare fraud diverts dollars and services from those that truly need it. While some people suffer and wait for treatment, others receive treatment they don’t need.
The FBI estimates that healthcare fraud costs as much as $80 billion per year!
With this as a backdrop, we were surprised to read a recent story in the Asbury Park (NJ) Press (APP). That story, entitled “Medicare: Does This Look Like Fraud to You“, paints a different picture.
Apparently at times the government makes mistakes and denies treatment to those who really need it.
The APP story discusses ambulance transports. Nowhere has there been so much Medicare fraud than in the use of ambulances to transport otherwise ambulatory patients.
Hospitals use ambulance transports to get people out of their facility so they can turn over beds and free up room for more patients. Dialysis centers get kickbacks to refer patients for twice weekly rides by ambulance, EMS providers’ upcode charges and claim they are providing advance life support services.
Things got so bad that last year the Centers for Medicare and Medicaid Services had to impose moratoriums on letting new ambulance companies become registered for Medicare.
Medicare pays $245 per basic ambulance transport plus $7 per mile. The charges are more if advanced life support is required. There is money to be made from Medicare and some ambulance companies truly game the system.
Between 2002 and 2011, the number of non-emergency trips in California increased 554%! Overall for the same time period those trips increased 94%. Clearly much of that increase involves Medicare fraud.
While we don’t doubt the specific cases cited by the newspaper, invariably everyone makes a mistake. Apparently some truly needy patients were denied services in the government’s zeal to stop Medicare fraud. While the government must take responsibility for its mistakes, we can’t help but think that these victims are the newest victims of Medicare fraud.
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