I recall a case where a doc billed PT procedures (because they can due to the AMA owning the CPT coding and despite the provider not being a PT!) and was caught in a fraud scheme. He and his "office girls" billed enough codes for some crazy number of practitioners (if I recall 7) and it was all billed under him. Basically, he had to have been working 24+ hrs/day to substantiate the billing. One would think with computers that would have been an easy case to figure out. It took Medicare years to figure this out. By the time they caught it/him, he had closed shop and run off. Medicare got zero from this. Again, wouldn't it be good to have a system to monitor something so obvious and blatant? Instead, Medicare cuts costs to PT providers (and many others) and tries to find fraud in small areas of people actually attempting to provide good care. It makes me sick to my stomach to fear the government when there are people blatantly fraudulently billing Medicare. Oh, don't forget the PT clinic that billed motor vehicle claims and had people walk in, sign in read magazines, not recent any PT and bill MVA claims! This stuff happens all the time. If you really want to save Medicare monies, stop foreign visitors getting free care when they arrive here, get diagnosed with cancer, receive full cancer care and fly home. A friend who worked at a community health care walk-in says they would routinely have 6 Nigerian men show up all with prostate cancer, get "diagnosed" and then get their treatments, then months later, fly home. All provider under free care. That would be a great whistle to blow except it somehow is legal?
I recall a case where a doc billed PT procedures (because they can due to the AMA owning the CPT coding and despite the provider not being a PT!) and was caught in a fraud scheme. He and his "office girls" billed enough codes for some crazy number of practitioners (if I recall 7) and it was all billed under him. Basically, he had to have been working 24+ hrs/day to substantiate the billing. One would think with computers that would have been an easy case to figure out. It took Medicare years to figure this out. By the time they caught it/him, he had closed shop and run off. Medicare got zero from this. Again, wouldn't it be good to have a system to monitor something so obvious and blatant? Instead, Medicare cuts costs to PT providers (and many others) and tries to find fraud in small areas of people actually attempting to provide good care. It makes me sick to my stomach to fear the government when there are people blatantly fraudulently billing Medicare. Oh, don't forget the PT clinic that billed motor vehicle claims and had people walk in, sign in read magazines, not recent any PT and bill MVA claims! This stuff happens all the time. If you really want to save Medicare monies, stop foreign visitors getting free care when they arrive here, get diagnosed with cancer, receive full cancer care and fly home. A friend who worked at a community health care walk-in says they would routinely have 6 Nigerian men show up all with prostate cancer, get "diagnosed" and then get their treatments, then months later, fly home. All provider under free care. That would be a great whistle to blow except it somehow is legal?
Absolute game-changer! (The time to get bodyguards was yesterday.)