Medicare Fraud: Why the Gov’t Is Spending Billions on Bogus Claims

Fraud in the Medicare system has been occurring for many years, but how bad is the problem? Very bad, according to a new Senate Investigations report which revealed the bogus claims that are submitted to the system every year that are simply being paid – no questions asked.

Paying for walkers for patients with sinus congestion?

Unfortunately, that’s not a joke. The system actually paid that claim. The Senate Permanent Subcommittee on Investigations looked at bills that were submitted by medical suppliers from January 2001 to December 2006 and discovered questionable claims for over $1 billion on only 18 items. The Subcommittee also looked at medical equipment claims over the 11-year period of 1995 to 2006 and found nearly $5 billion in bogus claims where codes were either left blank or were filled in with smiley faces – yet still paid. And that’s not the worst of it.

The report stated that there were hundreds of thousands of claims for diabetes glucose testing strips for patients with breathing problems, bubonic plague, leprosy and impotence – which demonstrates the degree to which the entire system simply isn’t taken seriously. Luckily, there are those that do take fraud seriously.

Whistleblower lawsuits increase

Whistleblower, or Qui Tam, lawsuits have increased over the past few years as more and more employees are coming forward and exposing their employers for fraudulent activity against the government. In fact, two lawsuits were reported in the past week alone. They include pharmacists with Walgreen’s exposing the retail giant for Medicaid fraud and senior legal counsel at Medtronic for exposing the medical device company for illegal activity relating to perks given to doctors for using its products. The issue has become a hot topic in the upcoming election as well. Both Presidential candidates Barack Obama and John McCain recognized this fraudulent activity in their recent debate and referenced the Medicare / Medicaid system in particular.

What can you do?

If you’ve witnessed fraudulent activity against the government (federal or state), contact an attorney right away. Whistleblowers, also known as relators, receive as much as 15 to 25% of the amount recovered depending on whether the government gets involved with the case. However, Qui Tam lawsuits must be handled with finesse and confidentiality. Click here, for additional information on Qui Tam lawsuits.