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Medicare Blog | Medicare News | Medicare Information

Medicare's Largest Single-Operation Fraud

Posted by Lauren Hidalgo on Fri, Oct 15, 2010 @ 10:13 AM

Medicare SupplementsThe largest single operation fraud in Medicare's history was lead by an Armenian crime boss, called a "vor," named Armen Kazarian where fake health care clinics and identity theft were used to cheat Medicare out of $163 million. Compared to a fraud franchise, Armen Kazarian and his co-conspirators are currently in custody and charged with racketeering conspiracy, bank fraud, money laundering, and identity theft. The investigation began when 2,900 Medicare patients in New York reported their information stolen; and, it was later discovered that the defendants had also stolen the identities of over 100 doctors in 25 states. The defendants created false clinics and phony paperwork that had doctors performing procedures outside of their specialties, raising flags. However unlike previous scams by others, when patients were bribed to sign up for procedures they did not need, these scams never directly involved patients or doctors. They were the result of stolen identities and false paper work; and, in New York alone, $100 million in fraudulent bills were submitted and Medicare paid out approximately $35 million to the scammers.

Medicare Cuts Costs of Medical Equipment

On January 1, 2011 the first of the baby boomer generation will begin qualifying for Medicare. In preparation of this sergeant of new people claiming benefits, Medicare will begin cutting the prices it will pay for some wheelchairs, oxygen concentrators, and other medical equipment by 30%. Beginning in the Inland Empire of California; as well as, Miami, Orlando, Charlotte, Pittsburgh, Cincinnati, Cleveland, Dallas-Fort Worth, and Kansas City, MO, this plan will not only lower the cost for American taxpayers but the Medicare recipient as well, with anticipated savings of $17 billion over the next 10 years. Counteracting the huge increase of health costs, the new plan will require companies to bid for the right to sell this medical equipment through Medicare in order to combat inflated prices and fraud. Bidding began last year, the list of winners will be released soon, and Medicare officials say the plan includes 48% small business. However, critics point out problems with this plan such as lack of binding commitments, the use of composite bids, flawed pricing, and a lack of transparency. Also, the critics fear that product supply and service will go down with the influx of new business. Some even wonder if the plan will really launch January 1st.

Medicare and Advanced Cancer

In a study conducted by Camelia S. Sima, M.D., M.S., of Memorial Sloan-Kettering Cancer Center, New York on 87,736 Medicare beneficiaries with advanced cancer, her findings revealed that screenings on advanced cancer patients with less than 2 years life expectancy serves no meaningful benefit. Thus, her study suggests Medicare deny coverage for those patient's screenings. Cancer screening's primary purpose is the early detection of cancer, and this process has resulted in the decline in deaths from cancer. However, in advanced cancer, screenings can lead to over diagnosis and causing unnecessary risk due to testing, biopsies, not to mention psychological distress. The study found that screenings were more common with patients who had a history of screening at regular intervals, since the use of electronic medical records that set reminders for procedures. Sima concluded that in limited life expectancy from advanced cancer, screenings were not found useful and therefore Medicare might not provide coverage for the procedure in those patients.

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Sources: The Associated Press, Redland's Daily Facts, Senior Journal

Tags: Medicare, Senior Market, Medicare News, senior insurance market news, Senior News

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