Salinas, CA: Senate Going After Labs Overbilling Medicare, Medi-Cal: View From A Private Duty Caregi
Salinas, CA: Senate Going After Labs Overbilling Medicare, Medi-Cal: View From A Private Duty Caregiver Serving Carmel, Carmel Valley, Carmel-by-the-Sea, Gilroy, Gonzalez, Greenfield, Hollister, King City, Marina, Monterey, Pacific Grove, Pebble Beach, Salinas, San Juan Bautista, Seaside And Soledad California
The latest Medicare scandal revolves around medical testing companies, which are now being investigated by the Senate Finance Committee for offering steep discounts if providers will send all tests to them for processing. There is also an ongoing investigation into whether Doctors are knowingly ordering unnecessary tests in order to get kickbacks from insurance companies. If this turns out to be true, it's likely a criminal investigation will follow. In light of our huge budget deficit and the weak economy, the government and insurance companies have been cracking down hard on Medicare and insurance company fraud, and there have been a record number of criminal cases recently against Doctors, clinics and others for overbilling in order to take advantage of the system. But if in fact there are kickbacks being given to Doctors and medical facilities, there will be fraudulent activities taking place on both sides of the table, not just the ones doing overbilling. The Senate Finance Committee has asked Aetna, Cigna, Laboratory Corp. of America, Quest Diagnostics and UnitedHealth Group to send copies of lab service agreements, contract information and corporate communications to them for investigating. Just this month, the State of California settled with LabQuest for $49 million and with Quest Diagnostics for charging California's Medicaid (Medi-Cal) five times more per case than it did to other customers. This is unconscionable. And that's just one state. Imagine the monetary ramifications if this is happening across all 50 states. Apparently the practice is not uncommon and is known as "pull-through," where labs sign contracts with insurers offering them a discount if they will verbally agree to have all their physicians send all of their Medicare and Medicaid cases to these labs. "The practice is blatant manipulation of Medicare to grow your market. We're talking billions of dollars per year," said Andrew Baker, a whistle-blower who refused to take part in the practice and eventually lost his business because he wouldn't commit fraud. This is a sad state of affairs. Medi-Cal and Medicare are having enough problems without dealing with blatant criminal activity like this. I hope the Senate Committee gets to the bottom of this and seeks repayment as well as fines and interest. The Medicare and Medicaid funds need all of the financial help they can get at this point.
http://www.usatoday.com/money/industries/health/story/2011-11-10/medicare-fraud-probe/51159336/1
About Richard Kuehn & Family inHome Caregiving of Monterey:
After more than a decade of caregiving, both in a professional environment and for a 97 year old family member I was dissatisfied with service from local caregiving agencies. I became convinced of the need for a service which provides very personal assistance to elderly and founded Family inHome Caregiving serving the Monterey Peninsula. Please visit my blog where I talk about important senior issues at:
http://www.familyinhomecaregiving.com/Blog
The latest Medicare scandal revolves around medical testing companies, which are now being investigated by the Senate Finance Committee for offering steep discounts if providers will send all tests to them for processing. There is also an ongoing investigation into whether Doctors are knowingly ordering unnecessary tests in order to get kickbacks from insurance companies. If this turns out to be true, it's likely a criminal investigation will follow. In light of our huge budget deficit and the weak economy, the government and insurance companies have been cracking down hard on Medicare and insurance company fraud, and there have been a record number of criminal cases recently against Doctors, clinics and others for overbilling in order to take advantage of the system. But if in fact there are kickbacks being given to Doctors and medical facilities, there will be fraudulent activities taking place on both sides of the table, not just the ones doing overbilling. The Senate Finance Committee has asked Aetna, Cigna, Laboratory Corp. of America, Quest Diagnostics and UnitedHealth Group to send copies of lab service agreements, contract information and corporate communications to them for investigating. Just this month, the State of California settled with LabQuest for $49 million and with Quest Diagnostics for charging California's Medicaid (Medi-Cal) five times more per case than it did to other customers. This is unconscionable. And that's just one state. Imagine the monetary ramifications if this is happening across all 50 states. Apparently the practice is not uncommon and is known as "pull-through," where labs sign contracts with insurers offering them a discount if they will verbally agree to have all their physicians send all of their Medicare and Medicaid cases to these labs. "The practice is blatant manipulation of Medicare to grow your market. We're talking billions of dollars per year," said Andrew Baker, a whistle-blower who refused to take part in the practice and eventually lost his business because he wouldn't commit fraud. This is a sad state of affairs. Medi-Cal and Medicare are having enough problems without dealing with blatant criminal activity like this. I hope the Senate Committee gets to the bottom of this and seeks repayment as well as fines and interest. The Medicare and Medicaid funds need all of the financial help they can get at this point.
http://www.usatoday.com/money/industries/health/story/2011-11-10/medicare-fraud-probe/51159336/1
About Richard Kuehn & Family inHome Caregiving of Monterey:
After more than a decade of caregiving, both in a professional environment and for a 97 year old family member I was dissatisfied with service from local caregiving agencies. I became convinced of the need for a service which provides very personal assistance to elderly and founded Family inHome Caregiving serving the Monterey Peninsula. Please visit my blog where I talk about important senior issues at:
http://www.familyinhomecaregiving.com/Blog
