Investigators believe Rashid’s companies’ fraudulently billed Medicare $126 million. Approximately $1.3 billion is believed to have been fraudulently billed in scams across the country.
Yet more evidence of how the U.S. health care system is broken
Better regulation, strict enforcement, price leveraging and controls are needed immediately.
This probably happens all the time, all over the country.
Shocked that they're getting charged.
People don't realize that a lot of the patch jobs the government wants to push forward with. Aren't going to really resolve the health care crisis we all face within the US. The prices of drugs and treatment must be lowered greatly before we can come to a rational conclusion for a working system.
'Fraud' pretty much describes the entire industry all of the time...
Is anybody shocked by this shit anymore?
Now can we charge congressmen from taking money from lobbyists?
Didn't the government getting involved solve this issue? Why would further scrutiny be.... worse...?
Ok... so the solution is... less oversight over the system? If they're capable of catching the exploiters I would think giving the regulators more resources would further the cause of catching people who abuse the system.
The idea of an unexploitable system is ridiculous, so I'm not sure why undercutting the system that protects itself is a solution
Can confirm they're a surgeon. That kind of word salad could only come from someone with a medical degree.
Canadian here ... and these kind of things don't happen in Canada. Canada regulates and standardizes pricing for all treatment. It's very rare that doctors will recommend needless drugs or procedures, because frankly, there's no profit motive for them to do so. They won't make more or less money. On the flipside, they typically recommend the best care when absolutely necessary, because it's not like it's going to cost the patient any more.
I'm sure there's some fraud going on out there, but in general, doctors here hate wasting time and money.
I get the sarcasm, but generally the fraud comes from rampant abuse of billing for things that didn't happen. The fact that you have older people that aren't paying for it, and also may not know exactly what is happening, while simultaneously trusting the doctors allows this. So you have doctors that do a simple check up and then write down a couple of other procedures that didn't really happen. Or order unnecessary tests and bill for lab work that is unneeded, whether or not it actually happens. What generally catches these schemes is like any case of fraud, evidentially the money flow gets so big that it can't go unnoticed anymore. Eventually someone starts adding two and two, and realizes that it's adding up to 10 and starts digging to see how you could possibly charge as much as you did for the number of patients you have. Because at the end of the day you can only see so many patients, for a certain number of hours, and that can only equal a certain amount of money.
So what like one surgery ?
I'm not sure if you're serious or not, but single payer wouldn't fix this, and that's ok. Single payer won't prevent this kind of fraud, but that doesn't mean it isn't worth doing.
So your point is that since the funding is from a public source people care less about the validity of the claims? Fucking a. Maybe if you gave resources to those enforcing the penalties, people would be less inclined to try to exploit the system since consequences surely follow.
Try that 'less incentive to keep costs down' on the IRS, son.
most doctors make about $200K a year.
which sounds like a lot...but it really isn't.they go to med school for 4 years, and rack up $300K in debt after med school they become a resident for 3/5 years(for surgeons) and make $35-$45K/yr after they finish being a resident, they can become a regular doctor and make ~$150K/yr if they aren't happy with making $150K/yr, they can do a fellowship 2-3 years(while getting paid $50K/yr) which specializes them and makes their starting salary $250K
so essentially, the doctors lose 7-12 years of actually making a living, while their $300K in debt accrues interest, while they aren't able to save a dime towards their retirement
so chances are, that 10 years after you get your bachelors, even if you graduated with a basket weaving degree, you'll still have a higher networth than a doctor and won't have ~$400K in student debt waiting to be paid off
And let's not forget, that for this little money, they have to work 70-80 hours a week, have only one day off for the rest of their lives, have a guaranteed one day a week where they have to be on call for 36 hours, and most specialties require you to be on call for emergencies if your patients have a problem
Anyone who is willing to go through this shit, deserves every penny they earn. Because doctors have a really low salary cap. They pretty much top out at $500K/yr with a few truly remarkable doctors topping out at 1-2 million. By comparison someone with the brains to be a doctor, could kill it in finance or as a lawyer, and make more than that after 5 years.
No. Budgets being cut due to not being spent and a need to ensure you spend everything due to a backwards accounting system allowing for inflation of prices due to desperation and necessity are why they don't keep costs down.
Your ignorance of financial systems and budgets is astounding
Seriously. I'm not shocked when greedy people do shady shit. I am shocked when said people are actually held accountable and charged with breaking laws. Pretty pathetic, isn't it?
They are rich, but most doctors aren't part of the 1%
To be 1% you need to make $465K/yr, and most doctors never see that kind of income.
That's the whole point of wealth disparity, peasants get jealous of doctors, meanwhile the really rich people make billions a year
Just in case people are under the impression that white US citizens are not a part of this shit too.
From a family of doctors, everything was good until the big companies came in, pushed our doctors our of their businesses, then offered them lower paying jobs at the local hospital or group that bought out. Patient visits tripled and quadrupled in cost. What used to be a visit to the doctor, suddenly became all about the type of visit. Don't even go into a consultation, you'll end up paying hundreds more. This isn't all, but it's certainly one important aspect of why we're paying so much more for healthcare than we used to. Helpful hint, if you're uninsured find a doctor who is not affiliated. Your costs will be much lower.
It looks like there's no significantly different health outcome in . Scroll down to the sections for Gorey/Cancer. From this review.
Of course if you're low income, Canada is better. And bear in mind these numbers are sitting at a slant already because this is just examining outcome, and Americans tend to spend more $ for the health outcome they get.
Certainly arguments to be made that the USA or American people subsidize the research into medical treatment that the other nations enjoy, that the results of other studies are conflicting, samples are too narrow and not representatives of outcomes elsewhere in the USA, reviews are just statistical witchcraft, etc.
No. It arose because the regulatory system around enforcing proper procedure is under financed and lacks proper resources to ensure valid claims. People do it cause the consequences are rare and sparsely enforced.
straight salary?!?! (aka Single Payer)
That's not what single payer means. When most people say single payer, they're talking about essentially having one big insurance company run by the government and paid for in part or in whole with taxes.
did you read the article? Billing fraud isn't an insurance problem. If you had single payer health care and the doctor submits false bills, you have the same issue.
I have no love for insurance companies, but you have to look at the problem correctly if you want a solution.
Holy shit. Auto download a PDF file upon going to the site? Really?
Blacklisting that site.
If anyone in this country deserves to make a lot of money it's physicians. Most of them work or have worked so many hours to get to the point they are that it would make your head spin. This perception that doctors are a bunch of fat cats who sit in their ivory towers all lining up to lazily scam the system is such a total crock of shit.
Yes...because the insurance industry is where the price increases begin.
The insurance industry is a "middle-man". In business deals...the middle-man inserts little into the actual transaction except for confusion and higher costs.
Get insurance OUT of the conversation and prices should, almost, self-correct as they would then be market based.
I'm not a "market is the solution" by any means. But the market isn't in the design at all any more.
Thank you! This is exactly how the order must happen. Fix the costs then talk about fixing the system.
I'm second generation Indian living in America are you saying I'm not American? Because my passport and birth certificate disagree with you
Even if they are, they are extremely likely to be culturally attuned to Pakistan or India -- people who come from those countries whether 2nd or 3rd gens still think like that. It's how they are raised.
Oh man, you're so fucking full of shit. I'm second gen Portuguese so I guess to you I'm not American enough because of my family's funny names. Fuck you, dick.
Of course they are Middle Eastern, money was probably funding some fucked up shit.
Because the US is a big place, with lots of people, and a free press, and you speak English? There is medical fraud everywhere.
I think they just need to streamline the process. I mean its totally archaic.
Really? The first thing you look at and focus on is their race?
I know that my primary care doctor had to close his business because of all the requirements and restrictions and delayed payments from insurance companies. Most of the ones I called to switch to have gone to cash only, you have to negotiate with the insurance company on your own. It's becoming more difficult to find a doctor who takes your insurance (and mine's not some small company). Insurance companies are paying slower and being more critical about what they will actually pay for which makes it hard for them. This whole system is screwing everyone.
Somehow gov't involvement in healthcare works just fine in every other first world country in the world - averaging half the cost of the US. Including nations like Italy and Greece which aren't exactly known for their governmental efficiency.
Why are you assuming they're not Americans?
I love living in Canada
Why are you also assuming these people aren't Americans? Because they have funny sounding names? Like Barack Hussein Obama?
EXACTLY! Consider the Florida has only FOUR Medicaid investigators.
Let that sink in.
Yeah I had a girlfriend who worked in medical billing/coding. Where I'm from it's common for all medicare/cade patients to get various tests that take almost zero time and skill and aren't justified in order to bill the government for it.
And they'd do it every visit for the patient too.
What they should be doing is offering financial rewards for whistle blowers similar to how they do for other financial crimes.
Fixed costs come with a non broken system.
They are able to charge what they want because the current insurance system allows then to do so.
Medicare is insurance you fucking idiot.
Taking a stab in the dark that it was sarcasm.
What a giant coincidence that 5/6 have foreign names.
I absolutely disagree.
Per Investopia.com - "When a good is inelastic, there is little change to the quantity demanded if the price of the good changes."
Are you suggesting, then, if the price of the good (healthcare) drops then quantity demanded by the market will remain unchanged? That's incorrect. There are innumerable stories of those in the US who cannot afford healthcare. However, they still desire healthcare when it becomes available/affordable. So I do not agree with the inelasticity you suggest.
Second, and this is anecdotal in nature, my father (a retired ENT) practiced medicine in the 70's (and forward) when insurance because heavily used in the US. His observation was that insurance would be the worst thing to happen to medicine. As born out in the article referenced in the title of this article, his suspicions are spot on.
I'll provide an example, if you've ever been to the Emergency Room, take a look at your bill the next time. Notice that the MD's costs are about $400/hr. (or so). Then there are the other costs: intake, supplies, RNs, etc. In terms of the MD's, at $400/hr. that translates into a salary of about $800k/yr. Do EM docs make $800k/yr? No...not even close. I think the normal EM salary is about $175K/yr. or so. Therefore, the difference of $625K/yr., where does that go? Lots of places I suppose, but it DOES NOT go directly to healhcare. It goes to "other"...and other, as defined by insurance companies, is overhead. It goes to everything BUT healthcare.
Therefor, insurance has pretty much been a scam from day one. It adds nothing but rules, regulations and extra costs to YOUR bill.
Insurance, before the 70's boom, used to be for big ticket things...like large operations or catastrophes. Not for the day-to-day maintenance of health.
Therefore, IMHO, insurance is NOT the answer...it's a parasite.
Here's a simple solution: there are two types of people in the US, those who have work sponsored healthcare and those who do not. All those who have work sponsored healthcare are fine...we don't need to worry about them. All the rest, charge them ONE DOLLAR PER DAY for their healthcare. That would create a monster pool of cash with which to PAY THE PROVIDERS. The government already has this system setup: Medicare and Medicaid. Then rework the cost of drugs (as big-pharma are lying sacks of shit who overcharge the US but not other countries - the US can be so stupid sometimes) and you've got a functional system which takes care of EVERYBODY and does so on the cheap.
But don't ever tell me that the insurance industry is good...that's just inaccurate. The insurance industry is NOT here to provide healthcare...they're here to create a profit for their owners/shareholders.