Healthcare Fraud in General
Various types of fraud occur across the healthcare industry. The most common types we see in the headlines concern Medicare and Medicaid fraud. Medicare and Medicaid are federal programs that fund and administer, in conjunction with relevant state health agencies, to insure the elderly and poor for healthcare. This can cover, in whole or in part, doctor visits, hospital stays, and even residency at nursing homes and long-term care facilities. Healthcare providers who falsely bill or overbill for services not rendered, or prescribe treatments or procedures that are unnecessary and then bill Medicare and Medicaid for reimbursement, commit fraud against the government and thereby the taxpayers. This activity is sometimes tied into kickbacks schemes whereby providers receive kickbacks for making patient referrals or using specific pharmaceutical drugs, which is generally illegal.
Such conduct also jeopardizes patients and nursing home residents if they are given treatments or procedures that are unnecessary and can cause trauma or injury. Furthermore, fraud can also occur when it comes to prescription medications. The Justice Department, U.S. Attorney offices, Department of Health and Human Services, and various states’ offices of Attorney General are all dedicated to rooting out fraud. Offenders can face civil lawsuits from the government to recover the money plus penalties, as well as face criminal charges and possible jail time.
Fake Cancer Treatments
In Detroit, a cancer doctor has been sentenced to 45 years in prison for his role in prescribing cancer drugs to patients who did not need those drugs. In September 2014, he pled guilty to 13 counts of Medicare fraud, two counts of money laundering, and one count related to kickback scheming. Some were cancer patients who did not need the types of drugs that the doctor prescribed, and some patients did not actually even have cancer. Yet the doctor misdiagnosed patients. In some cases, he told them they were terminal when they were not.
One report states that around 553 individual patients received infusions or injections that were not medically necessary. Some received iron treatments and blood plasma treatments for no reason – one person did not even have cancer. One particular patient received chemotherapy, which is known to make recipients very sick, for two and a half years in spite of the fact he did not even have cancer. To make matters worse, the cost of medical care for those suffering from the treatments may make it prohibitive for them to even get treatment they actually need right now. Another patient with testicular cancer receive unnecessary levels of chemotherapy and even had a testicle removed unnecessarily by the doctor. Another was given treatments for the wrong type of cancer, while the cancer he had continued to metastasize until that patient died toward the end of last year.
Nothing could possibly rival or surpass the unnecessary pain caused to patients who were given unnecessary treatments, but it bears noting the scope of the offense against the government and taxpayers as well. It has been reported that the doctor took in about $17.6 million from false reimbursements from Medicare as well as other private insurance companies, all for treatments he ordered for cancers or conditions he completely made up. In addition to jail time, he will have to give that money back. The expansive damage to his patients, however, cannot be reversed.
See Other Blog Posts: