Taking Stock: No prescription can cure Medicare fraud
Apr 06,2009 00:00 by Malcolm_Berko

Dear Mr. Berko: I'm an actively employed physician in Central Florida. I recently discovered that a party unknown to me had used my Social Security number to charge more that $5,000 of neurological test to Medicare. So, as a good citizen, I decided to do the right thing and report this fraud that took place in Miami to Social Security. Well I called my Social Security office on three occasions and no one cared enough to follow through or ask me questions. On my fourth call, I got a little testy and the person to whom I spoke gave the phone number to a Social Security fraud hot line. With a renewed vigor, I called the hot line twice, but no one answered so I left a detailed message. No one called back. So I wrote a detailed letter to the commissioner of Social Security in Washington, D.C. I still haven't received an answer. I have the billing details, the name of the billing neurologist in Miami, the name of the patient, the description of more than 30 individual neurological tests, dates, locations, etc. — all of which are fraudulent. I as well as millions of working Americans are paying for these charges and it's no wonder Medicare and Social Security are going broke. Anyhow, I've sent copies of these charges, names, dates, etc. for your review. I would appreciate any advice you can give me on how to report this fraud so I can get some satisfaction that there is at least one person in this vast government bureaucracy who cares. M.D. — Tampa, Fla.

Dear Doc: About five years ago I had a 6-inch piece of titanium screwed into my lumbar spine. I spent three days in the hospital. I was billed $63,000 for the operating theatre, $14,200 a day for a two-person hospital room, $90 for a saline drip, $135 for a morphine drip and more than $3,000 for bandages. My entire hospital bill came to $143,525.18 and the surgeon services added $36,400 charges. Cheese and crackers got all muddy. Talk about fraud, especially when the saline solution costs $2.86, the morphine drip costs $3.92; bandages from Johnson & Johnson cost less than $9 retail. The surgeon got $4,600 and the hospital was paid $1,200 a day for my room. I could never figure out why the hospital billed $1,200 per day for my room, $63,000 for the operating theatre when they know Medicare will only pay 15 percent to 20 percent of the billing costs.

Defrauding Medicare and Social Security is a burgeoning cottage industry and with the assistance of Medicare and Social Security personnel (some of whom are paid to aid and abet this fraud) it's estimated that about 32 percent of the combined monies paid out by Medicare, Medicaid and Social Security are fraudulent.

You're right as yellow tulips and daffodils, very few people at those government agencies give a fig in Finland about this pervasive fraud. I've received similar letters from readers in Texas, California, Illinois, Ohio and Pennsylvania and some readers even wrote their representatives in Congress. All they got back was a silly form letter thanking them for writing with assurances that their representative cares about this problem.

So, unless you're willing to take this to a higher level, spend a small fortune to hire a private investigator to identify and gather evidence against the perpetrators and employ an attorney to prosecute, you will be tilting at windmills. The entrenched interests are powerful enough to avoid, to stall and sidestep any investigation into suspected fraudulent activities. It's common knowledge that tens of thousands of people are involved in frauds like these on a daily basis. We read about it in the newspapers, see it on television, but can you name just one occasion in which one person has been caught and prosecuted?

So Doc, just "fuhgetaboutit" and spend your time healing the sick. Fraud in Medicare and Social Security are as common as cars in a parking lot. And because many government employees benefit from the increased workload they are reluctant to report these infractions. That's the way the system works. So, like it or lump it, but whatever you do please be careful because I've heard that some powerful forces can come back and bite you in the butt. You could even lose your license to practice. My dad used to tell me that a fool's paradise can be a wise man's hell.

Please address your financial questions to Malcolm Berko, P.O. Box 1416, Boca Raton, FL 33429 or e-mail him at malber@comcast.net.

Copyright 2009 Creators Syndicate Inc.