Unfortunately, Medicare fraud is not a new thing. It has been around for years, though it has grown over the years to a multi-million dollar business. Whether it is unscrupulous sales people selling bogus supplemental policies to unsuspecting seniors or whether it is people sending in claims with dead doctors’ identification numbers or other creative ways to cheat and defraud the Medicare system, there are many ways that the system has been bilked out of millions of dollars – in fact, researchers say that it is now over a billion dollars.
In California, three hospitals have stooped to a new low. The hospitals are accused of picking up homeless people from the skid row area of downtown Los Angeles and bringing them to the hospitals with fake conditions. Once these people were admitted and served their usefulness by being set up for fake treatment for the fake illnesses, they were then shoved back into the ambulance and dumped back off on skid row.
Skid row is a very poor area of downtown Los Angeles where there are quite a large number of homeless individuals, so it was an easy place to perpetrate this hoax. “Runners” working for the hospitals as recruiters would get homeless people to go to a center near the hospital where they were assessed and where their Medicare and Medi-Cal were verified. Once this was done, the recruiters created the information regarding the conditions for these individuals – conditions which would get them into the hospital and get Medicare to pay the bill to the hospital.
The biggest problem is that these homeless individuals didn’t really realize what was happening and didn’t really get treated for those fraudulent conditions, when they may have actually had some actual conditions that needed to be addressed and treated. Sadly, the recruiters actually guaranteed certain numbers of these “patients” to the hospitals and once these individuals were treated – minimally – and released, everyone got paid to the tune of millions of dollars. Each of the homeless individuals was paid $20 to $30 after being released from the hospital.
One thing that the hospitals and their administrators – who were indicted on various charges – did not realize is that they were being closely watched by the FBI. This became their undoing. The FBI and local law enforcement raided the hospitals within the past few days and arrested administrators and others involved in the schemes.
With fraudulent schemes like these and some of the other issues that plague the Medicare system it’s no wonder that overhauling the system and prosecuting fraud to the full extent of the law is essential and needs to happen right now, as this situation in California shows.
The issue of immigrants and aliens in this country has been heated for years. It is something that has been discussed as the population has changed – especially in the past decade. Sometimes, however, both sides of the debate seem to forget that this is a nation that, other than Native Americans, was largely built by immigrants. Yet, these days, there are big questions that keep coming up about immigrants, aliens and paying taxes or having certain types of benefits, especially health insurance coverage.
One state that has a huge issue with aliens is California, due to many factors. Many of the state’s citizens are individuals that are aliens, and though the insurance coverage controversy is limited to aliens that are legally here – green cards and all – there is still a huge issue surrounding these individuals and their benefits.
To offset budget issues, Governor Schwarzenegger has proposed and is fighting for limiting or eliminating health care coverage for immigrants/aliens that have had a green card for less than five years. This proposal would supposedly save $85 million or more by eliminating many preventative services for those individuals and their families. The problem with this is that, once again, it’s great to look at the short term but the long term must be addressed. If people do not have Medicaid coverage (called Medi-Cal in California), to help them stay healthy, studies throughout the count.ry in various states have shown that the costs are often much more in the long term because without preventative and basic care, people wait until their health situation is acute before they deal with it. Because people wait until they can wait no longer, they end up in an emergency room instead of a doctor’s office, therefore incurring a cost that can be up to an average of 7 to 10 times that of a preventative or even an acute visit to the doctors office. A doctors visit at a local clinic usually costs between $10 and $25; and a doctors visit at a private doctor’s office can be $35 to $100 depending on what area of the country a person is in. With Medicaid, a doctor’s visit would cost a co-pay of $10 to $20. All of these are far less than the average emergency room visit which can cost from about $200 to $2000, depending on where you are and the procedures that have to be done. The likelihood of a low-income individual paying the doctors visit or working out payments with or without insurance, is much better than them paying for the hospital visit. Too many times, the hospital gets stuck providing care and receiving little or nothing because the person truly has no money and the hospital is obligated not to turn anyone away.
It is important to keep an eye on California to see how the Governor’s bill turns out. Let’s remember that aliens that are legal and have green cards have taxes taken out of their paychecks, thus contributing to the economy. It is essential to weigh the pros and cons as well as the financial impact of cutting these individuals out of insurance benefits/Medicaid coverage that could essentially keep them and keep the economy healthier.
