Nursing Home/Healthcare Billing Abuse Out of Control

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The Americas Watchdog Corporate Whistleblower Center has just released the results of a year long study focused on Medicare & Medicaid that shows widespread billing abuse involving all aspects of healthcare. According to the report, in most cases examined, nursing homes, hospitals and or individual doctors are involved, and as usual its the US tax payer picking up the tab.

The Corporate Whistle Blower Center has just reported its 2005 year end findings on the state of Medicare/Medicaid over billing/fraud in the United States, and according to the groups President Thomas Martin ,"the results are grim". The report included the top five areas where Medicare/Medicaid was over-billed or defrauded as follow:

1. Nursing Homes/Rehab Centers taking advantage of loop holes in Medicare/Medicaid billing proceedures that allow for widespread testing that should not have been done or were not needed. As an example an elderly patient on Medicare/Medicaid is admitted to a rehab center/nursing home with no speech problems and is sent to a speech therapist for a battery of unnecessary speech tests, or speech therapy at a cost of $5000-$10,000+. Unnecessary testing of Medicare/Medicaid patients costs the US Taxpayers tens of billions of dollars per year in unnecssary billing/fraud.

2. Most Nursing Homes/Rehab Centers are not providing anything close to mandatory time/hours per day with patients under their care. Nursing homes, rehab centers, and in some cases hospitals are required by Medicare/Medicaid to spend minimum hours per day, per patient. In most cases examined this is not happening in US nursing homes. This very wide spread practice puts at risk the patient and exposes the tax payer to a bill that should not have been paid. Needless or premature death/illness are a frequent result.

Another major result of the investigation was the discovery that illegal workers, who make up a very large percentage of all nursing home employees nationwide. Frequently these workers do not have a working knowledge of the English language. According to Thomas Martin President of Americas Watchdog; "its kind of hard to offer care to a nursing home patient on Medicare/Medicaid, if you cannot understand what the patient is telling you about their condition".

3. Doctors or Doctor Partnerships requiring Medicare/Medicaid patients to endure unnecssary testing or duplicative testing that fleeces the tax payer, and may put the patient at extreme risk. As an example, the investigation discovered Radiologists requiring the same patients to undergo the same types of testing, from other partners in the same practice group, or Cardilogists requiring heart patients to undergo the same heart tests from other cardiologists within the same practice group. Duplicative/Unnecessay medical testing/proccedures may account for 10% to 15% of all Medicare/Medicaid bills. Once again the tax payer gets stuck holding the bag at a cost of tens of billions of dollars each year.

4. Doctors perscribing the most expensive drugs (rather than generics) also account for up to 10% of all Medicare/Medicaid over-billings. While doctors can no longer take trips, or get lavish rewards directly from drug makers for perscribing the most expensive drugs, they can become a "consultant" for the drug company, and end up with the same type of lavish reward. According to Martin, Americas Watchdog, " its common that a drug company's "loyal" doctor" gets to become a drug company's "consultant", and then gets a first class, 7 day trip to Hawaii, where the doctor/"consultant" might give a one hour speech on the positive affects of an ED drug-to an empty room".

5. Botique hospitals, not for profits, or hospitals owned by doctors/investor groups are largely unregulated, and are not typically, on any federal, or state radar screen, with respect to the billings/compliance, related to Medicare or Medicaid patients. The net result of this; the taxpayer loses again. While large hospital systems or chains are forced to play by the "rules", with respect to physician recruitment, and or billing; not for profits, and or botique hospitals frequently do not play by any rules. According to Martin, "the only rule is how much money can we make and or where do we send the bill"?

City, County, State or Federal (aka VA) owned hospitals are also not held to any acceptable standard, with the net result being massive over-billing, fraud, or waste of precious Medicare/VA & Medicaid dollars. In the instance of government owned medical facilities, more patients, more medical staff, more administration, and more billings are all good things. Americas Watchdog Martin explains," this is because of the government employee motto; "if we don't use all of our money this year, we will not get as much money or more money next year". The net result is waste, fraud or abuse of Medicare/Medicaid that may dwarf the other four listed problem areas combined.

The Corporate Whistle Blower Center is always very interested in talking to healthcare workers/managers who might possess substantial proof related to Medicare or Medicaid over-billing or fraud. Individuals with substantial proof may be able to receive a significant reward for revealing their information. Americas Watchdog is the parent of the Corporate Whistleblower Center and would encourage individuals with information related to Medicare or Medicaid over-billing to contact us for a confidential interview.

If you are a law firm or a lawyer with a practice area that includes Qui Tams, Nursing Home abuse, Hospitals or class actions, Americas Watchdog has enormous reach in the investigation of, or in consulting on these types of cases. We also form Qui Tam partnerships with investors to expose wrong doing to federal agencies for a portion of the whistle blower reward.

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Thomas Martin
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