When Your Doctor Goes to the Beach, You May Get Burned

News and Commentary

When Your Doctor Goes to the Beach, You May Get Burned - Studies show that most doctors feel they can take advantage of the free offerings of the pharmaceutical companies without being influenced. [New York Times Healthcare News]

If they think this, they can take advantage of drug company perks without feeling guilt. This reminds me of an article earlier in the month Making Drugs, Shaping the Rules where State government officials argued that they are not influenced by pharmaceutical companies funding their disease management programs.

Healthcare Fraud in South Africa

News and Commentary

Here’s a good article about fraud control in South Africa.

One of the things they talk about is calling patients when a doctor billed more services in a day than he could possibly perform. A key to making that work well is being able to identify outliers immediately and call patients before they forget the service or move. Often analysis like this is not done for a least a month after the claim was paid, which can be long after the service was provided. Having a report within 24 hours of processing the claims (and before th

Miami Medicare and Accident Scam

News and Commentary

Around South Florida Fri, Jan. 30, 2004 Miami Herald

“Federal agents Thursday arrested eight Miami-Dade residents accused of spearheading a two-tiered fraud of both the public Medicare system and private automobile insurers to the tune of $5 million.”

Back in August, I said that auto accident fraud rings were also committing health insurance fraud, because they already had the perfect setup. Tacking on healthcare fraud to the accident fraud would be almost pure profit (Accident Ring).

State moves against one of state's top Medicaid drug prescribers

News and Commentary | Medicaid Fraud Cases
State moves against one of state’s top Medicaid drug prescribers - AP via Florida Times-Union Feb 3 2004 4:27AM GMT [Healthcare Management News]

The State of Florida accused Dr. Armando Angulo of inappropriately prescribing over $2 million of Oxycontin and other narcotics since 2000. According to this article, Dr. Angulo even let clinic staff hand out pre-signed prescriptions on days he was not in the office.

Read my article about Oxycontin abuse

Making Drugs, Shaping the Rules

News and Commentary
Making Drugs, Shaping the Rules - The drug industry has eagerly helped states set medication guidelines for new antipsychotic medicines. [New York Times Healthcare News]

Whenever I hear about States funding disease management programs with money from pharmaceutical companies I get a little queasy. It feels like having the fox design and build the hen house.

In this article Melody Petersen tells us about how pharmaceutical companies helped pay for development of guidelines that recommend new drugs for the treatment of schizophrenia—drugs that cost $3,000 per year per person, instead of $250. “A Johnson and Johnson subsidiary that sells Risperdal, paid $4,000 to fly two state mental health officials to New Orleans, where they dined at an elegant Creole restaurant in the French Quarter, visited the aquarium and met with company executives and Texas officials,” she reports.

Medicare Considers Curbs on Payment for Cancer Drugs

News and Commentary
Medicare Considers Curbs on Payment for Cancer Drugs - Federal Medicare officials are close to deciding whether to refuse to pay for unapproved uses of expensive cancer drugs. [New York Times Healthcare News] Once the FDA approves a drug for a certain use, doctors can prescribe the drug for other uses, without any evidence that the treatment is effective. This is a big problem in cancer treatment, where patients and their families are often desperate to find a cure. They have the idea that anything is better than doing nothing, no matter the cost (especially if they are not the ones paying for the treatment). In fact, the side-effects of cancer drugs can be far worse than doing nothing, especially given that the drug may not be at all effective.

Costs and Savings in Medicare Change on Wheelchairs

News and Commentary | Fraud Cases | Medical Equipment Fraud Cases | Medicare Fraud Cases
Costs and Savings in Medicare Change on Wheelchairs - Medicare administrators late last fall began to take a closer look at reimbursement requests for power wheelchairs, an effort now saving the government millions of dollars. [New York Times Healthcare News] The beginning of this article talks about the hardships of small businesses and patients who are having trouble getting Medicare to pay for power wheelchairs. Sure, new rules may make it more difficult for everyone to get Medicare to pay for power wheelchairs, but the rules were enacted to control terrible abuse of the system.

February 2004 Newsletter


This Month’s Report:
News and Observations
Steps for Fraud Control
New Look for Website

In the news this morning, I read about Halliburton Co. allegedly overcharging the US government over $16 million for meals at a cafeteria in Kuwait. According to the news reports, they served about 14,000 meals a day but charged for three times as many. This reminded me of the many times I’ve seen healthcare providers billing for services they didn’t provide. It costs the healthcare industry billions of dollars a year.

What is worse is when this same greed leads healthcare professionals to provide services that aren’t needed. In addition to the cost we all pay in higher insurance premiums and taxes, the patient pays in unneeded suffering. Occasionally, providers become especially greedy and get caught performing three times as many open-heart surgeries as their peers, providing thousands of unneeded dental services to kids on Medicaid or conducting unneeded eye surgery on mental health patients. But more often, people are simply snookered.

Fraud News December 2003


Fraud FAQ and Quotes

Reporters often contact me. I put together a list of frequently asked questions and answers that can help journalists respond to tight deadlines for articles about fraud.

Three Million Dollar Medi-Cal Eyeglass Scam

Owners of L&M Diamond Jewelry Optical wer convicted of stealing $2.98 million from Medi-Cal by filing claims for eyeglasses that were lost, stoled or destroyed.

Eyeglasses Scam

Bonus - Free Algorithm

Read about how to create an algorithm to find eyeglasses fraud and other similar abuse. You must login first to access the article. You’ll need to login to the website by entering your username and password in the Client Login menu on the right-hand side of any page of or by visiting user login. If you haven’t registered as a user before, Sign up. This is not the same as signing up for e-news.

Fraud News September 2003


Fraud Forecast Summer 2003

I predict that in the next year we’re going to see a lot more cases involving growth hormones, stolen provider identities, counterfeit drugs, and excessive surgeries. These kinds of cases show that both fraud and fraud control are getting more sophisticated.

Read Fraud Forecast by visiting this link.

Lipitor Fraud and Waste

The cholesterol lowering drug, Lipitor, is an expensive maintenance drug taken by a large percent of the adult population. Most people who take Lipitor have no symptoms. A cholesterol test showed that they have high cholesterol, so they get the prescription. Once prescribed, patients will take this drug until something new replaces it. These factors make it the perfect drug for a pharmaceutical company’s bottom line. They also make it a target for fraud.

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