Tag: health

MEDICARE FRAUD INVESTIGATION

As always, the contents of this blog constitute a compendium of multiple media reports supplemented by my personal opinion, where indicated.

As most of you know, the Department of Justice in conjunction with various other federal agencies has been investigating allegations of massive, pervasive, Medicare fraud throughout the US. This problem first came to light some months ago with the disclosure of alleged fraud in Minnesota. Federal and state authorities have been conducting massive, ongoing investigations into Medicare and Medicaid fraud in that state. The Department of Justice (DOJ) and the Minnesota Attorney General’s Office have executed what the media has described as a series of “historic joint takedowns” of dozens of individuals and medical providers allegedly participating in extensive schemes involving false claims totaling hundreds of millions of dollars. It has been further alleged that politicians such as Governor Tim Walz, Attorney General Keith Ellison, Congresswoman Ilhan Omar and others were cognizant of these schemes but chose to turn a “blind eye” for political reasons. Most of the media has underreported this matter, but now it has burst wide open.

It has long been suspected that this fraud was not limited to MN. Accordingly, the DOJ has been conducting its own countrywide investigation. Last Tuesday the DOJ announced what it termed the “2026 National Health Care Fraud Takedown.” This historic nationwide enforcement action charged 455 defendants, including 90 medical professionals, across 45 states for allegedly submitting $6.5 billion in false Medicare and Medicaid claims. Officials said cases were filed in 56 federal districts and territories, with all 50-state Medicaid Fraud Control Units participating. The blatant and brazen degree of audacity and greed will make your blood boil especially considering that many of the victims are the weakest and most defenseless among us – the sick, the elderly and children. Acting AG Todd Blanche described it as “the greatest combined federal and state effort combatting healthcare fraud in history.”

The MN scheme was particularly egregious since it funneled money to Somali nationals, many of whom were in the US illegally to boot, who, in turn, funneled the funds to Somali terrorist organizations located in Somalia.

These schemes come in many forms, but the most common one is medical identity theft combined with fraudulent billing. Typically, fraudsters steal Medicare numbers, which enables them to bill the government illegally for expensive medical treatments, tests, or equipment that were never needed, requested, or provided.

A few of the many examples:

  1. Los Angeles is a hotbed of abuse. HHS Secretary Robert F. Kennedy, Jr. characterized LA as a “hive of hospice fraud” denoting, tongue in cheek, that an inordinate number of hospice patients “never die.” The Anti-Fraud Task Force headed up by VP JD Vance suspended payments to approximately 800 hospices and home health agencies in the city. Additionally, federal prosecutors have commenced criminal charges against ten doctors who were illegally prescribing controlled substances.
  2. Businessman Ibrahim Khaldoon Hilmi is accused of running a medical supply business that submitted $3.7 billion in false claims for equipment that patients never received.
  3. Nurse practitioner Marizel Yukee won the dubious prize for the highest level of fraud. According to the indictment, she is accused of billing $906 million for medically unnecessary treatments. She owned mobile clinics in four states from which she targeted elderly Medicare patients many of whom were terminally ill and under hospice care. Moreover, she allegedly billed for medically unnecessary amniotic wound treatments that were applied to vulnerable patients through an illegal kickback and bribery scheme. Authorities allege the treatments were applied to infected wounds, wounds that had already healed and wounds that were not responding to treatment. Prosecutors also allege that she falsified patient records to make it appear that these procedures complied with Medicare requirements. Authorities seized much of her property that she had acquired through these schemes, including a $594,000 Ferrari and an $865,000 necklace.
  4. Last year the federal authorities recovered nearly $220 million from the State of Texas related to criminal and civil Medicaid fraud judgments.
  5. CA consistently ranks among the top states for total fraud dollars and volume of federal investigations. As a result, federal authorities have taken the unusual step of deferring portions of its state Medicaid reimbursements.
  6. In Illinois Dr. Daniel Robinson billed Medicare for $67 million for “counseling and therapy services.” According to prosecutors obviously, this was a fraudulently inflated amount since his company was not large enough to generate that size of a bill even if all the employees worked 24 hours a day.
  7. Historically, Florida has had a reputation for massive health care fraud schemes involving telemedicine, genetic testing, and durable medical equipment. In a particularly egregious case, a high school basketball player died during practice after his doctor had approved his cardiovascular test results as being normal even though the student had pre-existing cardiac issues and despite the fact that the doctor had only given the test results a “cursory glance.”

CONCLUSION

I believe that this story had been underreported by the mainstream media until yesterday. In my opinion, this was partly due to the attention being paid to the more dominant issues such as the war with Iran, the economy, and the upcoming midterm elections. Moreover, the initial story involved MN, which is a state controlled by Dems, and the perpetrators were largely Somali illegal immigrants. I am glad the DOJ made such a huge splash to bring this to the attention of the general public.

As I discussed above, this widespread fraud is unconscionable on its face. I’m glad that the DOJ is prosecuting the perpetrators. However, I think it should also prosecute the politicians who were responsible for supervising these people. Either they didn’t know about the schemes, which would constitute an abject failure of their duty to supervise, or they did know and aided, abetted and covered it up, which is just as bad.

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MY HERO

July 5 will mark the nine-year anniversary of the most horrific day in the lives of my wife and I, a day no parent should have to endure. Eventually, the ordeal had a happy ending, but it was touch and go for a while. Subsequently, I shared our experiences in a blog entitled “My Hero.”

As the aforementioned anniversary approaches I would like to re-publish the blog as I do every year at this time. (Some of you are new followers of my blogs and may not have seen it.) I believe it is as inspirational now as it was then. Perhaps, you could forward it to a friend or relative who has suffered a stroke, or other live-threatening health issue, and might benefit from reading it. So, read, enjoy and be inspired by “My Hero.”

“Who is your hero? Who has inspired you by exhibiting extreme courage and achievement in the face of adversity? Is it a historical figure, like George Washington or Abraham Lincoln, or a religious figure, like Moses, Jesus or Muhammed, or maybe, a civil rights icon, like Martin Luther King or Nelson Mandela? Or, perhaps, it might be an ordinary person you know or know of who, while not famous, has accomplished something so truly remarkable, against such long odds that you are truly inspired. Not all of us can point to such a person, but I can. It is someone very close to me that I have known all his life. It is my son, Matt.

It all began on July 5, 2015, a day I will never forget. Like the JFK assassination and the 9/11 terrorist attacks I will never forget where I was and what I was doing when I heard the awful news. It was a typical summer’s day in the NYC area, bright and sunny. Matt was enjoying a family day with some friends and his lovely wife and two young children at a local club. Suddenly, after swimming in the lake he became dizzy, lost vision in one eye and collapsed. He had suffered a dissection of his carotid artery, which had triggered a massive stroke.

Luckily, there was a doctor present. He immediately recognized what was happening and knew exactly what to do. This doctor accompanied Matt in the ambulance and stayed with him at the local hospital to ensure that the ER doctors gave him the clot-buster shot and other appropriate treatment, including emergency surgery to remove the clot within the five-six-hour window that is considered to be optimal for treating strokes. This certainly mitigated the effects of the stroke and may even have saved his life.

My wife and I were eating dinner with friends at a local restaurant when we got the shocking telephone call that Matt had suffered a stroke. It seemed impossible. Matt was only 40 and in excellent physical condition. He worked out regularly, ran, and practiced jujitsu. The caller did not know any details, not even if Matt were alive. If you’re a parent, you know that type of telephone call is as bad as it gets. Luckily, our friends insisted on driving us to the hospital in Westchester to which Matt was being transported (the Westchester Trauma Center). I don’t think I was in any condition to drive. We arrived at more or less the same time as Matt. We were able to see him and ascertain that although he was in very serious condition, he was alive. After the surgery he was only able to breathe with the aid of a ventilator, and his skin was the color of white porcelain.

Over the next few days the medical news was very dire. The doctors confirmed that Matt had, indeed, suffered a massive stroke. He was not conscious; he was paralyzed on his right side; he might need a craniotomy; he was blind in his left eye; and he had only partial vision in his right eye. He was in such bad shape that I felt elated a few days later when I squeezed his hand and felt him squeeze mine back.

The doctors told us he was facing a long, arduous recovery, one – two weeks at the hospital followed by six to nine months at a rehab facility. In addition, they said there was a good possibility that he would never recognize us, speak, or be able to walk unassisted. As far as returning to a normal life as a husband and father and resuming his career as a senior research analyst, that was seemingly too unrealistic to even contemplate. (Later, Matt told us that one of the doctors had flat-out told him he would not recover sufficiently to do so. When we asked him if that had bothered him, he said “no, I knew he was wrong.”). I realize that doctors feel compelled to disclose all possibilities, but there is a natural tendency to focus on the most negative ones, and that was an extremely disturbing prognosis.

Over the next year. Matt made a remarkable recovery. He was discharged from the hospital in only six days and transferred to the Burke Rehabilitation Hospital in White Plains, NY for rehab. Not only did he have to rehabilitate himself physically, but he also had to rehab his mind and his memory.

At first, he didn’t even recall very basic elements of his life, such as the names of his wife and children and his current address. He had to relearn how to speak. His rate of progress was beyond anyone’s most optimistic expectations. He attacked his rehab with a vengeance. He attended every session. He never once told them he was in too much pain, too tired, or not in the mood, as many rehab patients do. Many times he would cut short our visit by telling us he had to leave for a rehab session. If they told him to do ten of something, he would do 15. He would complete the most tedious and frustrating of tasks without complaint. His course of rehab included robotics, which helped considerably. Of course, it helped that he was only 40 years old and in excellent physical condition, but, nevertheless, he astounded the doctors, the therapists, and, indeed, even us with his progress.

In August 2016, after less than one month at Burke, he was discharged. For a while, he continued to undergo private rehab once a week. Now, he exercises by running.

CONCLUSION

Matt’s astounding recovery included the following accomplishments:

1. He completed his rehab at Burke and returned home to his family well ahead of schedule.
2. The day he was discharged he accompanied his wife and son to Nassau Coliseum, which was over a one-hour drive, to see Billy Joel’s last concert there.
3. He climbed up to the top of the Statue of Liberty.
4. He has resumed his career as a senior research analyst at a Wall Street firm. This is a remarkable achievement since his job is very demanding, requiring many hours of complex analysis, a high level of prolonged concentration, high-level meetings with clients, and travel.
5. He has completed the NYC marathon and various half marathons and works out regularly. How many non-stroke victims can say that?
6. Most importantly, has resumed his role as husband and father, and my wife and I have our son back.

During his recovery period Matt was fond of saying his full-time job was to get better. He applied the same single-minded determination and dedication to that task as he has to everything else in his life. He is not all the way back to where he was, but if you were to meet him today for the first time you would likely not realize that he had suffered a massive stroke only a few years ago.

My wife and I know that Matt was extremely lucky that there was a doctor present who ensured he received the immediate care he needed as well as benefiting from an amazing support system of friends, relatives and colleagues, and, for that, we will be eternally grateful. However, the determination with which he attacked his rehab virtually willing himself to get better was nothing short of amazing!

We have always been very proud of Matt, but, now, he is and will always be, our hero.”

Even now, nine years later, it is hard for me to read this blog without getting emotional. We know we dodged a major bullet. Matt has pretty much returned to normalcy, although he is still blind in one eye and has a weakness in his right hand. However, I remain optimistic that one day medical science will progress to the point that he will regain his sight. Who knows?

We have suggested to Matt that he could become an inspirational speaker to give others the benefit of his experience. Although he has made a couple of appearances with a friend who was also a stroke victim, for now, he has chosen to focus on his family and career.

Alternatively, his experience would make a fine inspirational movie, although Hollywood would probably dismiss it as too unrealistic. Indeed, as the saying goes, truth is stranger than fiction”

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