Bonneville America Forums Forums Off Topic Discussion Forums Lounge Forty Six Year Old Friend Had a Stroke

Wow, what a thread! Its been a while since I posted anything and now to read/scan through this...

All I have to say is I am glad I stuck out my 20 in the navy. When it was to0ugh to stay, this is what kept me waking up. Well this and the retirement for life. Some of the people at work say "Yea, but you got your military ins." I say YOU BET YOUR A$$. I DID MY 20, I fullfiled my end of the bargin, now they have to hold up theirs. Oh, and thank you very much for not serving your county.

but thats all ill say aobut this. Other than I agree with the statement made was out of taste and selfish.

You served out 20 years in the military. You earned ya perks for your service. Much respect to ya for it.


My beef in this whole mess is the callous indifference toward a fellow man.

The health care system needs a lot of repairs and maybe even revamping. Many are doing the best they can with what they got. For many the situation is not good.

Stats from the Coalition Against Insurance Fraud;

Health Insurance•

One of five U.S. adults — about 45 million people — say it's acceptable to defraud insurance companies under certain circumstances. Four of five adults think insurance fraud is unethical. (Four Faces of Insurance Fraud, Coalition Against Insurance Fraud, 2008)

• Nearly one of four Americans says it's ok to defraud insurers (8 percent say it's "quite acceptable" to bilk insurers, and 16 percent say it's "somewhat acceptable.") (Accenture, 2003)

• About one in 10 people agree it's ok to submit claims for items that aren't lost or damaged, or for personal injuries that didn't occur. Two of five people are "not very likely" or "not likely at all" to report someone who defrauded an insurer. (ibid)

The U.S. spends more than $2 trillion on healthcare annually. At least three percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)

Fraud accounts for 19 percent of the $600 billion to $800 billion in waste in the U.S. healthcare system annually. Fraud amounts to between $125 billion and $175 billion annually, including everything from bogus Medicare claims to kickbacks for worthless treatments and other services. (Thomson Reuters, 2009)

The Justice Department launched 903 new health-care fraud prosecutions in the first eight months of FY 2011 more than all of FY 2010. This is an 85-percent increase over FY 2010, a 157-precent increase over FY 2006 and 822 percent over FY1991. If the national trend continues at this pace, 1,355 prosecutions will be logged by the end of FY 2011. (Transactional Records Access Clearinghouse, September 2011)

• Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)

• Medicare paid dead physicians 478,500 claims totaling up to $92 million from 2000 to 2007. These claims included 16,548 to 18,240 deceased physicians. (U.S. Senate Permanent Committee on Investigations, 2008)

• Nearly one of three claims (29 percent) Medicare paid for durable medical equipment was erroneous in FY 2006. (Inspector General report, Department of Health and Human Services, 2008)

Medicare paid more than $1 billion in questionable claims for 18 categories of medical supplies that patients don’t appear to need. The study covered claims between January 2001 and December 2006. The claims included walkers for patients with purported sinus congestion, paraplegia or shoulder injuries. Hundreds of thousands of claims were made for diabetes-related glucose test strips for patients with purported breathing problems, bubonic plague, leprosy or sexual impotence. (U.S. Senate Permanent Subcommittee on Investigations, 2008)

1. New York Presbyterian Hospital

The Columbia Presbyterian Division paid $480,000 in 2003 for improper billing as well as upcoding. Currently, the Government is demanding $8,000,000 in back payments for improper billing of medical trainee costs.
The Weill Medical College division paid $4,400,000 for misuse of funds awarded by the National Institutes of Health.


2. Yale University School of Medicine

In 1999 paid $5,500,000 to the Medicare Program for allegedly providing care by medical residents without proper supervision by attending physicians in violation of PATH regulations.

Another example of this pattern of putting financial considerations ahead of patient safety, Yale had to pay another $5,500,000 in settlement of a lawsuit brought by staff Radiologists who alleged that the Medical Center was permitting inadequately trained staff to read x-rays.

3. Johns Hopkins University School of Medicine

In 2003 paid $800,000 for violations of the PATH regulations to Medicare. In 2004 they paid $2,600,000 for noncompliance with federal research grants charging the Government more than was actually spent.

4. Harvard University Hospitals

In 2003, a $75,000 fine for PATH violations at the Massachusetts General Hospital for patient care delivered by residents that was unsupervised by any attending physicians.

Beth Israel – Deaconess, in 2002, paid $5,400,000 for improper billing to Medicare and procedures performed with experimental cardiac devices that were not approved by the FDA.

Harvard and Beth Israel Hospitals, in 2004, paid $2,400,000 for misuse of research and training grants. The Massachusetts General Hospital had to repay the State Medicaid program $1,5000,000 for double billing in 2002. The Attorney General Reilly commented "In tough state budget times when programs are being slashed and the Medicaid budget is stretched to it's limits, it is crucial that providers who receive overpayments return them to the Commonwealth."

5. The Cleveland Clinic

In 2003, paid $4,000,000 to Medicare for claiming that supervising doctors had performed services that had actually been performed by medical trainees.

In 2004, $2,300,000 was paid for false cost reporting (in the Home Care division).
The Cleveland Clinic Florida Hospital in 2005 had to pay $2,750,000 to settle allegations that they had billed for services that were actually to which they were not entitled.

6. University of Illinois College of Medicine and University of Chicago Hospitals

In 2003, the University settled a lawsuit for $2,000,000 with the Federal Government and the State of Illinois for allegedly exaggerating the seriousness of the medical conditions of liver disease patients. The alleged goal was to perform liver transplants on patients who were not currently in need of a transplant. This was to insure the Hospital performed the required number of transplants necessary to maintain their Medicaid and Medicare Certification. The alleged end result was that patients who did need transplants in other facilities might not get them. Similar allegations were "settled" against Northwestern Memorial Hospital for $23,587 and the University of Chicago Hospital for $115,000 The actions were brought by Patrick J. Fitzgerald, United States Attorney.

In November, 2005, the State of Illinois joined a "Whistleblower Suit" against the University of Chicago Hospitals. The allegations are that at Chicago-Comer Children's Hospital from 1997-2005, the Hospital routinely ignored State regulations regarding the distance infants must be kept from one another in the neonatal ICU. This is called "double-bunking" and places infants at risk due to the risk of spreading infection. The Hospital is alleged to have "double-bunked" neonates in order to inflate their reimbursement from Medicaid.


7. St. Louis University (a Tenet Hospital)



In 2003, paid $1,800,000 to Medicare to settle allegations that services were provided by unsupervised medical trainees in violation of PATH regulations.

8. Montefiore Hospital and Medical Center



In 2004, Montefiore paid $12,000,000 to settle allegations that the Hospital failed to repay it's debt to Medicare and that it had conspired to hide this debt for 6 years. The Hospital had allegedly misstated it's costs to Medicare and when the overpayment was discovered through an audit, it then allegedly conspired not repay the money. $5,600,000 was simply erased from their books, and they refused to pay another debt of $4,200,000.


9. University of Washington



In 2004, paid $35,000,000 for overbilling Medicare; billing work retroactively to Medicare; and billing Medicare for work performed by medical trainees as though performed by attendings.

This is the largest teaching hospital settlement that exceeds the $30,000,000 paid by the University of Pennsylvania in 1995. (see below)



10. Kaiser Permanente


In 2005, paid $1,000,000 to Medicare for false claims after previously paying $900,00 for inaccurate Medicaid claims.

In 2003, Kaiser settled a lawsuit (the details were kept under seal) by several consumer groups that they

"tied a significant portion of doctors' pay to meeting quotas to limit medical services and applied quotas for doctors to reduce the number of patients hospitalized regardless of medical need."

In 2005, a former Kaiser doctor filed a lawsuit that he was fired after charging that "cost-cutting moves put patients' lives in danger..." In order to save costs, the Doctor alleged that in "...case after case patients were denied and delayed care and suffered gross misdiagnosis with serious harm."

The Kaiser Papers is a comprehensive source to review the vast extent of malpractice (and worse) conducted by the Kaiser organization.

11. New York University Hospitals



In 2004, paid $2,100,000 for false claims for obstetrical services provided by midwives, unattended residents, and uncredentialed doctors.

12. University of Pennsylvania (Clinical Practice)



For the years 1989-1994, triple damages of $30,000,000 were paid to the Government for unsupervised medical trainee services as well as “upcoding” (that is, billing for more complex level of care than provided).

In 2005, the University had to pay the Government $1,000,000 for misrepresenting the toxicity of gene studies when the study should have been terminated (in response to the death of a teenager undergoing gene therapy). "Among the alleged lapses were repeated failures to halt the experiment when serious toxicities first arose; failure to fully disclose the study's dangers in informed-consent documents; and statements falsely suggesting that earlier patients in the study had benefited from the treatment."

Details of the allegations against the involved physicians, who, if the allegations are true, were acting entirely like "Nazi Physicians" can be found on the CIRCARE website of the father of Jesse Gelsinger (the deceased "gene therapy" patient)


13. State University of New York, Health Science Center (SUNY) Brooklyn

In 2003, paid $655,000 for PATH allegations (faculty not personally involved in care delivered by trainees).


14. Northwestern University

In 2003, paid $5,500,000 for overstating the percentage of researcher work on federal grants

15. San Diego Hospital Association

In 2003, paid $6,200,000 for misstating organ acquisition costs for 1981-1999.

16. Fort Collins Hospital (Colorado)

Paid $2,900,000 in 2003 for Home Health Care reporting fraud and double billing on physical therapy.

17. St. Mary’s Hospital (Grand Junction, Colorado)

Paid $1,250,261 in 2002 for Pneumonia upcoding

18. University of Colorado Hospitals

In 2005, had to pay Medicare/Medicaid/Tri Care Champus $755,000 for overbilling. This was after previously
paying $1,200,00 for Medicare overbilling in 2001

19. Methodist Hospital (Houston)

In 2003, paid $2,750,000 for improper billing to Medicare for procedures using unauthorized experimental cardiac
devices.

20. Hackensack University Medical Center



In 2002, paid the Government $314,000 for unauthorized procedures using experimental cardiac devices.

21. Blue Cross of California

Paid the Government $9,250,00 for falsification of cost report audits to Medicare in 2002.

22. Catholic Healthcare West

In 2001, paid $10,750,000 for improper charges to Medicare for unauthorized experimental cardiac devices.


23. The Regents of the University of California (scroll down to 2/2/01 and 2/21/01 on linked document)

In 2001, the Regents were required to pay the Government $2,300,00 for PATH violations. Also, in the same year, a total of $22,500,000 had to be paid by UC Davis, UC San Fransisco, UC Los Angeles, UC Irving, and UC San Diego also for claims submitted to Medicare for services provided by unsupervised medical trainees, undocumented bills, as well as billing irregularities.

24. Loma Linda University

In 2004, $2,200,000 was paid to the Government for PATH to settle allegations of PATH violations.

25. Texas Tech University Health Sciences

In 2001, paid the Government $2,300,000 for PATH allegations and upcoding.

26. State University of New York (SUNY) Stony Brook

Paid $850,000 for double billing for pharamaceuticals.

27. The Mayo Foundation

In 2005, $6,500,000 was paid to the Government for charging costs that were unrelated to research projects that were sponsored by federal grants.

28. The University of Medicine and Dentistry of New Jersey

In 2005, $1,407,448 was paid to settle PATH allegations.

29. Staten Island University Hospital

In 2005, $76,500,000 had to be paid to settle allegations of Medicaid overbilling.

30. Temple University

In 2004, $1,875,000 was paid to settle PATH allegations.

Coronal mass ejection heading toward Earth

Just thought I would lighten the mood.

The corruption the politics the fussing and arguing. It aint worth it. There is a solution , status quo is not it.
The man who disagrees with you in political view is not your enemy. He is just as frustrated as you and wants an answer. We are all swimming in lies. There are more lies from people with an agenda than truths.

Great info and I'm against welfare fraud as much as the next guy, but most of these violations are interns and clerks making gross mistakes on coding with no criminal intent. Or they are hospitals making errors using old or incorrect overhead cost factors or figures. No doubt there are bad players with intent to defraud and the book should be thrown at them. No surprise concerning fraudulent "scientific" studies sited, we've seen a lot of that in the last decades. Thanks for the info.

Thanks Chad. I beleive Matt (Leithel) and a few others on here have probably had teh same conversation with people at some point also.

No doubt the regulations are vague and contradictory. All one has to do is look at IRS regulations and contradictory advice given by IRS agents. Personal note here; I had a tax question a few years back and was advised by 3 agents how to handle it. I did exactly as they instructed. Three years later, the IRS notified me that I was in error and had to not only pay the tax, but also added penalties. Eighteen months of discussion (including documentation of earlier advice). They ultimately ruled against me and I had to pay over $9000 in tax, penalties and interest.

My wife worked in Billing/Coding for a few years - in both private medical practice and for a "consolidator" that did billing for hundreds of physicians nationwide. A real sweatshop! The name of the game is revenue for the practice. You screw up or don't meet your quota and you're unemployed. For example; You go to the doctor for a pain in your shoulder and mention another ache. The doctor, if he doesn't require you to make another appt. for the second complaint, leaves it up to his staff to decide which of the two conditions will generate the greater return from the insurer and lists that first. Knowledge of ICD-9 and CPT codes is crucial and medical offices now have staffs that do only this. The Office Manager actually runs the practice with the doctor delegating so much authority to that person, that it's almost as if he were an employee. And then if he doesn't send you for every conceivable test procedure, you and your lawyer will sue him for either Malpractice or Errors & Omission.

I guess the point of posting the earlier data was to show that this is not a Republican or Democrat, Left or Right problem. It really irritates me when people point fingers at one side or the other. The problem is the system itself. A system that has been created by lobbyists on both sides of the aisle to generate either revenue or job security for their benefactors. We the people are left to suffer the consequences.