According to authorities, health care fraud is the most expensive crime in the nation, with losses of up to $80 billion annually for federal health insurance. Central Texas in particular spends quite a bit more than the average on home health care than the national average, with 45 percent of home care agencies having questionable billing. Authorities say that part of that high cost is due to health care fraud.
Multiple doctors have been accused of health care fraud after home health care agencies sent patients to them in order to file somewhat phony bills to Medicare. Some of these included therapy plans that may not have been needed or may have been altered to garner a higher payment. Apparently many of the elderly patients had no idea what was happening, and indeed some of them weren’t even seen by a doctor. Others reportedly went along with the scheme in exchange for gift cards or even food stamps.
In other instances, patients were given a wheelchair or a walker while Medicare was allegedly billed for a more expensive power wheelchair. Apparently it was not uncommon for certain home care agencies to bill Medicare for a more expensive item than was actually used. The process was said to be simple, and one man reported that all it took was looking up the billing code for medical equipment online.
For some cases, it is possible that the fraud may stem from a simple misunderstanding of the law and what Medicare will and won’t pay for. Home health care is usually only for those who are physically unable to leave their house, and it involves therapists who are working toward rehabilitating the patient. Only a few home caregivers have been indicted while several central Texas doctors have been indicted in relation to the supposed health care fraud. If convicted, these involved doctors could face several years in prison along with hefty fines.
Source: dallasnews.com, Dallas area home to huge health care frauds, Jim Landers, Feb. 15, 2014