Silicon Investor (SI) -- The First Internet Community

STOCKTALK

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor. We ask that you disable ad blocking while on Silicon Investor in the best interests of our community. If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.

Politics : President Barack Obama -- Ignore unavailable to you. Want to Upgrade?

To: RetiredNow who wrote (132019)	3/19/2013 11:55:58 AM
From: Alex MG	Read Replies (1) \| Respond to of 149317

once again, you blamed our medicare system on "socialism" as opposed to a "free market" system... my point was a single payer system would solve a lot of problems... our current free market for profit system is what is driving costs through the roof... also i agree there needs to be changes such as a 70 year old patient with liver disease because he was an alcoholic should not be allowed a $400,000 tax paid liver transplant just to prolong his life a few months... Social Security is not a problem... runaway health costs and people gaming the system are the problem "...CBS correspondent Steve Kroft on "60 Minutes" Sunday, December 2, 2012, charged Health Management Associates, Inc. (HMA) with running unnecessary tests and admitting patients without cause all to drive up revenue. Based in Naples, Fla., HMA is the nation's fourth-largest for-profit hospital chain. According to the "60 Minutes" report, HMA hospitals pressure doctors to admit patients by setting admission quotas. Dr. Clifford Cloonan and Dr. Scott Rankin, two former employees of HMA, were among a handful of former HMA workers interviewed by “60 Minutes,” who said the company has a benchmark of 20 percent admissions for emergency room patients. Patients older than 65 have a 50 percent benchmark, they said. This was done, in part, through the use of computer software (Pro-Med) that the doctors said automatically prescribed a battery of tests for patients even before doctors had seen them and suggested admission of patients. The doctors said that admitting patients who did not need to be admitted exposed them to "medical misadventure," including an increased risk of infection. "It has nothing to do with patient safety and patient care. It has everything to do with generating revenues," Rankin said in the report. Doctors who fail to meet those quotas are allegedly penalized by hospital administrators and sometimes even fired. All of the doctors interviewed by “60 Minutes” who complained about HMA's admission practices had been fired by the company. At least one - Paul Meyers, HMA's former director of compliance and a 30-year FBI veteran, who accused the chain of Medicare fraud - is suing HMA for wrongful termination. The "60 Minutes" report took more than a year to complete, during which time the news team talked with more than 100 current and former HMA employees. Nationally, according to the report, an estimated $210 billion each year — about 10 percent of all health-care expenditures — goes toward unnecessary tests and treatments. Much of that cost comes from taxpayers via Medicare and Medicaid payments. Medicare fraud - like that alleged at HMA - has cost the federal government and taxpayers billions of dollars. Common types of Medicare fraud include: Phantom Billing - Billing for services that were never delivered to patients. Billing for inappropriate or unnecessary procedures or services that are not medically necessary. Charging for equipment and/or supplies never ordered. Billing Medicare for new equipment but providing patients with used equipment. Upcoding - Billing for a more serious (and more expensive) diagnosis or procedure then the one actually performed. Kickbacks - Financial arrangements between health care providers where providers provide some material benefit in return for other providers prescribing or using their products or services. Doctors are supposed to decide on the most appropriate treatment for their patients without consideration of their own financial interests. Kickbacks often result in medically unnecessary treatment. Submitting multiple bills, in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill. Double Billing — Charging more than once for the same service. There are a number of state and federal laws that protect and encourage “whistleblowers” to come forward and report Medicare fraud, including: The False Claims Act – allows citizens with evidence of fraud against the government to sue, on behalf of the government, in order to recover the stolen funds. In compensation for the risk and effort of filing a “qui tam” case, the whistleblower or "relator" may be awarded a portion of the funds recovered, typically between 15 and 25 percent. The New Jersey Conscientious Employee Protection Act (CEPA) – prohibits an employer from taking retaliatory action against an employee who discloses, objects to, or refuses to participate in any conduct that the employee reasonably believes to be illegal, fraudulent or in violation of public policy. The attorneys at McMoran O’Connor & Bramley, P.C. have substantial experience representing whistleblowers in the healthcare industry. If you aware of fraud involving Medicare, pharmaceutical misconduct or other activity involving government reimbursement or payment for health care, or believe that you have been retaliated against for reporting or complaining about such fraud, you should contact us immediately. We are thoroughly familiar with the particular needs of whistleblower clients and will fight to protect your rights.