PERSONAL BAGGAGE
A Tale of Marriage, Medicine and Murder

Is there still corruption in Medicare?

Answer

There is still corruption in Medicare, a national insurance program administered by the U.S. Federal Government, and in Medicaid, through which the state and federal governments provide medical coverage to one-third of all children, low-income pregnant women, disabled or blind people, and nursing home patients.

One example of health-care fraud would be “up-coding,” when a health-care provider incorrectly classifies the services it provides to recover higher reimbursements. Another example is billing for a treatment that was not provided, which Flossie Mae confides to Penny is one of Dr. Scales’ practices. (p.166)

In 2011, civil health-care fraud cases brought in $2.4 billion under the False Claims Act, while the Justice Department filed criminal charges against 1,430 people for health-care fraud, the most cases ever in a single year.

On Wednesday, May 3, 2012, hundreds of agents swept the nation, raiding businesses, seizing documents and charging suspects in Baton Rouge, Detroit, Houston, Los Angeles, Miami and Tampa. Federal authorities charged 107 doctors, nurses and social workers with Medicare fraud in a nationwide crackdown on unrelated scams that allegedly bilked the taxpayer-funded program of $452 million, the highest dollar amount ever in a single Medicare bust.

In May of 2013, the United States Medicare Strike Force charged 89 individuals in eight cities with alleged participation in Medicare fraud scams, resulting in $223 million in false billings.

The Chicago Tribune printed on January 27, 1914, that Passages Hospice, LLC falsified levels of hospice care and that its forty-five-year-old leader, Seth Gillman, had been charged with health-care fraud and obstructing a federal audit.

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Chapter 1: Chapter One
24.
"... River Park Hospital to the corporation that built Jacksonville Medical Center?” “No, but I know many hospitals are struggling because Medicare and insurance companies have cut back reimbursements.” Penny faced her neighbor. “I’m changing jobs: I am going to work full-time at ..."

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Chapter 6: Chapter Six
"...happen several times lately,” the tech said. “I guess we didn’t know how much it happened before Dr. Wiseman had the policy changed. Now, we automatically check a hematocrit with every type and crossmatch. The bad part is that if a patient’s hematocrit doesn’t meet criteria, Medicare and insurance won’t pay for his admission and work-up.” ..."

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Chapter 13: Chapter Thirteen
94.
"... Did he really need one? What was going on between Buck and Dr. Scales? Migraine headache and angina would not have to be proved by lab results, but anemia and low potassium both required lab verification to meet Medicare standards. Would Buck falsify lab results? Flossie Mae said she gave a ..."

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Chapter 16: Chapter Sixteen
"...Flossie Mae stared out of the window. “Last week, our X-ray machine was broken, and Dr. Scales made me pretend to take a chest film. He told the patient he had pneumonia, and he billed Medicare for the X-ray and an antibiotic injection, but he didn’t order any injection and I didn’t give one. He gave the man a prescription and told him to come back next week.” ..."
"...Medicare and Medicaid have guidelines you have to meet. So do insurance companies, but most of our patients don’t have insurance. In the chart notes, the patient’s symptoms must match the diagnosis and the treatment. So I’ll look up the billing code to see what Dr. ..."

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"...had been discharged, and Carina took care of Mrs. Banks and an outpatient who left before midnight. Penny spent most of the night reading PARALYZED, a paperback thriller one of the patients had left behind. In it the villain said he gave up importing cocaine because scamming Medicare and Medicaid was easier, less dangerous, and just as lucrative. ..."

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Chapter 26: Chapter Twenty-Six
16.
"... federal custody after posting a $100,000 cash bond. “Edwin York, special agent in charge of MBI’s Medicare fraud unit, says the case dramatically illustrates how some corrupt medical personnel abuse the system for their personal gain.” Oblivious to taste, Penny consumed cheese-eggs, ..."

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"Margaret McMillion’s novel intricately weaves a woman’s personal doubts and life trials into the intense and stressful operations..."

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