A couple of psychologists got caught in the nursing home scandal. Group therapy with dementia patients they said. They got prison time and lost their licenses. Medicare has been spending a lot of time checking out nursing home fraud. Medicare pays low rates but it adds up.

Yeah, that's why they should get audits and be controlled more.
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That is ridiculous. It is hard enough to get paid by insurance companies. That is what is driving Docs to a concierge practice. Cash only, no insurance unlimited time with the doctor.

A local psychiatrist is facing felony Medicaid fraud charges (along with several civil cases).

He was the doc in charge of a local behavioral health ward. Claimed to be performing daily face-to-face evaluations on each of the up to 74 patients in the unit, which were billed to Medicaid.

After getting tipped off by a whistleblower, the investigators' review of the security cam footage revealed that the doctor would walk down the center hallway of the ward with his laptop on a rolling lectern, glancing into each of the rooms for a few seconds as he rolled past, and then billing that as his "face-to-face evaluation".

He'd spend 15-20 minutes at work each day. And after reviewing hundreds of hours of footage, the investigators never once observed him actually enter a patient's room or interact with a patient. Yet he was billing Medicaid $800k/year for these "visits".

What a crook! Hope they make an example of the guy with prison time.

He was the doc in charge of a local behavioral health ward. Claimed to be performing daily face-to-face evaluations on each of the up to 74 patients in the unit, which were billed to Medicaid.
^^^^^^^^^^^^
Patients were better off not seeing this guy.

Another reason I'm appalled at what the medical profession has become.
Fee for service billing under Medicare and the seemingly inescapable temptation to game the system--practiced by everyone--has led to reimbursement rates that are ridiculously low. Spoke with an anesthesiologist in the neighborhood, who says his income has remained the same for 35 years because of ratcheting downward of Medicare reimbursement rates. I know this is the case from my previous practice; although since we were on salary the Medicare reimbursement rate never affected us.

The really egregious Medicare fraud cases seem usually to come from foreign doctors who set themselves up in practice in a relatively small town where there is little competition; and where--for a while, at least--outrageously high surgery rates for, e.g. coronary artery bypass surgery--may be overlooked.

quote:

The really egregious Medicare fraud cases seem usually to come from foreign doctors who set themselves up in practice in a relatively small town where there is little competition; and where--for a while, at least--outrageously high surgery rates for, e.g. coronary artery bypass surgery--may be overlooked.

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The problem is exacerbated by insurance using the already low Medicare rates. There is little gaming the Medicare system in mental health since there are only a few codes and the rates are low. You are right some medical specialites get ridiculously high rates. Administrators make the big bucks now,

I waited a year for my first appointment after I had thoroughly vetted him. He was from the area and twenty years younger than me. He had no problem disagreeing with me and Always offered same day appointments if you called first thing in the morning. He has been my physician for over twenty years.

Wonder if there were any whistleblowers. If anyone finds themselves in this situation, here's what you need to do: https://www.jdsupra.com/legaln...awsuits-for-2487454/

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