Read a pretty interesting article about how identity theft is being used (more and more frequently) to commit healthcare fraud. The article also alleges that organized crime is exploiting this activity to their financial advantage.
Since organized criminals normally are hard to get a “quote” from, we’ll have to speculate about how much they are involved in this phenomenon.
The article written by Jim McKay appeared in govtech.com and quoted a section chief (Sharon Ormsby) from the FBI:
At least 3 percent of U.S. health-care costs (about $60 billion) can be attributed to fraud, according to the National Health Care Anti-Fraud Association. Of that, 1 percent is attributed to medical ID theft - an ominous figure when the numbers are triangulated, according to Sharon Ormsby, section chief for the financial crimes section of the FBI.
“If you figure by 2012, national health-care expenditure costs for the country will be approximately $3 trillion, you look at the fact that the National Health Care Anti-Fraud Association conservatively estimates health-care fraud to be 3 percent to 5 percent of that expenditure amount,” she said. “That’s a significant amount of fraud, so we do have a strong interest in it.”
Another interesting article related to the subject of healthcare fraud showed up in the news in the past few days, also. CBS News did a story about a “whistleblower,” who turned in his superiors — in this instance a hospital — for fraudulently billing government healthcare programs.
Unlike the govtech.com article — which only suggests a dollar loss — the CBS piece estimates the cost of healthcare fraud at about $11 billion a year.
Sharyl Attkisson, a CBS correspondent covered this story and it points to more commentary about government waste in general on the Couric (Katie) and Co. blog.
Please note the whistleblower in this instance received $3 million for turning in his employer.
With the baby boom generation headed for retirement and reports of hospitals going under because they provide free healthcare for illegal immigrants, there is a lot of camouflage for healthcare fraud to hide in.
The fact that a hospital was in on the fraud shouldn’t surprise a lot of people, either. If you are following the 2008 election, the subject of legitimate companies gouging the healthcare system for profit isn’t a new topic.
There is little doubt that the subject of healthcare costs is a hot topic and will continue to be for a long time to come.
Govtech.com article, here.
Here is a story, I did in May that covers the ties between healthcare fraud, organized crime and illegal immigration:
Medicare Fraud arrests might expose ties to medical identity theft and organized crime
Loading ...
1 user commented in " Does healthcare fraud tie into organized crime, illegal immigration and …. corporations? "
Follow-up comment rss or Leave a TrackbackIf you want to play behavioral health care professional, the state of North Carolina is your fantasy camp.
In my four years as resident of this state, I have encountered quite a number of professionals who exaggerated or manufactured degrees, somehow obtained employment, and somehow managed to retain employment even after the matter was brought to the attention of their employer, for example, one major health and hospital system in Greensboro with an old school mob mentality. We’re talking graft, patronage, and just the right amount of shiftlessness when it comes to detecting and mitigating noncompliance with federal law, billing rules, and professional ethics.
One woman employed as a clinical social worker for this hospital does not hold a license in clinical social work. She did not complete the requirements for licensure and allowed her provisional license to expire, which at this point means that she would have to start over from scratch. According to the North Carolina Social Work Certification and Licensure Board, this individual is prohibited by law from referring to herself as a clinical social worker. The Joint Commission (JCAHO), after a routine evaluation of the facility, reprimanded the hospital’s Social Work Department, at which time the employee settled on the obscure and unregulated title of “medical social worker” (anything but plain old social worker). But a few months later, clinical social worker worked its way back on her badge, her voicemail, and all hospital support group and panel discussion fliers. A few months after that, the Social Work Board investigated the matter by telephone and informed the concerned critizen complainant that the social worker in question was not responding to their letters. The hospital appears to be doing its best to preserve and disguise the impropriety.
At the same hospital, a licensed professional counselor (LPC), a master’s level license, refers to himself as “doctor” and “psychologist.” It has been confirmed that this employee’s services are being billed out to Blue Cross and Blue Shield at the doctoral level. A few months after some insurance companies were alerted to the possibility of fraud, the hospital, which continued to employ him, removed his name from the web site. Efforts were made to capture previously cached copies of the hospital’s web site, but the hospital made some changes to its metafiles, preventing search engine robots/crwlers/spiders from making old copies available.
At the same hospital, a licensed psychological associate (LPA), also a master’s level license, refers to herself as a “licensed health psychologist” on fliers for all panel discussions and support groups in which she advises groups of cancer patients on the issue of coping with chronic illness. The licensed health psychologist title commands the title “doctor” and implies a PhD (doctoral dissertation), thousands of additional hours of supervised practical experience, and more rigorous examination for licensure. This is no small distinction, especially when you consider that university programs often give out master’s degrees as door prizes to students they withdraw from their program because they do not think the student is doctoral material.
In another city, a substance abuse counselor for decades misrepresented himself by maintaining he received a B.A. from a school he never attended and by claiming to have a PhD from an accredited graduate program. The PhD program from which he graduated, which accepts students with no college education is, as you might expect, unaccredited, making him ineligible for licensure at any level. Apparently he also failed to obtain the CCAS he also claims, meaning this man with a PhD, has no professional mental health licenses at all. For all this misrepresentation - for years of masquerading as a doctor to an inestimable number of people - he received a letter of reprimand from the North Carolina Substance Abuse Professional Practice Board. One wonders how his services are being billed out to insurance companies.
So, the moral of the story is, if you want to pretend to be a mental health professional, North Carolina is the place for you.
Leave A Reply