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The Knucklehead of the Day award

Today's winner is Staten Island University Hospital. They get the award for the following-

NEW YORK, Sept. 15 (UPI) -- Staten Island University Hospital in New York has settled a Medicare fraud case for more than $25 million, an attorney says.

Attorney Richard Reich, who represents whistle blower Elizabeth M. Ryan, said in a news release Monday the hospital has agreed to settle the False Claims Act lawsuit.

The 2004 lawsuit filed by U.S. officials in federal district court in New York alleged the hospital and its former chief of radiation oncology, Dr. Gilbert Lederman, knowingly billed Medicare for a cancer treatment not covered under the federal program.

By billing Medicare for the stereotactic body radiosurgery treatments, hospital officials were able to earn millions of dollars, Reich alleged.

"Staten Island University Hospital sought to exploit the Medicare program and obtained millions of dollars in payments which it was not entitled to at the expense of vulnerable cancer patients, as well as the public," the attorney said.

I honestly think a good chunk of the medical providers nationwide engage in some kind of fraud. Whether its against their own patients, or by overbilling governments for Medicare and Medicaid. I say this with some justification. Not just based on personal experiences, but read here and here how one of the biggest hospital chains in the US and the biggest medical school in the country got caught and fined. If Tenet Healthcare gets fined almost a billion dollars, it has to make you wonder.

Staten Island University Hospital is today's Knucklehead of the Day.


Comments (8)

Bill, if you had a cancer t... (Below threshold)
epador:

Bill, if you had a cancer that would be better treated by stereotactic radiotherapy, and Medicare denied payment because it is "experimental," I think you'd be awarding the Knuckle-head to them. I got out of oncology 11 years ago because I got tired of fighting insurance companies , including Medicaid and Medicare, to pay for appropriate treatments for my patients. When I got stuck with a bill for $14,000 of drugs for one patient, I knew I had had enough. The patient did fine, bu the way.

You do live in Florida, tha... (Below threshold)
Imhotep:

You do live in Florida, that's what is expected in Florida. Most of the "creative billing" and fraud cases that I am aware of come from Florida and New York.

Look again at your MRI EOB; notice how the charged rate was nearly $3200, and the paid rate was $800. I wonder how you would feel if you were only paid 25% of the charges by your customers. Other service providers (plumbers, attorneys, contractors) would take your ass to court and have a field day with you.

Dentists, on the other hand, get paid what they charge. And when the "insurance" (which is just a savings account)runs out,they just wait til next year. Imagine an M.D. denying services like that!!

BTW, I am not defending rea... (Below threshold)
epador:

BTW, I am not defending real fraud, and this case probably is real fraud.

The way Medicare determines fraud for most community providers is that they randomly pick a small sampling of charts and review one billing episode from each. If there are errors, they then make a dramatic assumption, and multiply the dollar amount of error in the charts by the total Medicare volume for the practice and request that amount of money back immediately. Errors are considered fraud.

Even if they find one error, if it is a big one, it can be VERY costly.

I'll see your entry Bill, a... (Below threshold)

I'll see your entry Bill, and raise you by the Long Island Rail Road and the federal government. LIRR employees have been running a disability and benefits scam that has cost taxpayers $250 million since 2000 and countless millions more in salary adjustments that allow someone with a base salary of $50k to make triple that amount after overtime and other special adjustments.

I honestly think a good ... (Below threshold)
ExSubNuke:

I honestly think a good chunk of the medical providers nationwide engage in some kind of fraud.

True that. Last year, I was entitled to have safety glasses purchased for me by my previous employer. I payed for the exam (as was listed in company policy), they ordered the glasses from a wholesaler, and had them shipped to a local optometrist. Now, bear in mind that this optometrist didn't give me the eye exam, and had NOTHING to do with the procurement of the glasses. I went to pick them up, which consisted of walking in, giving my name, signing for the glasses, and walking out. 5 minutes, tops.

About 2 weeks later, I recieved a bill from the optometrist's office for "processing fee."

I still refuse to pay them. Credit report be damned.

It helps to remember that t... (Below threshold)

It helps to remember that the billing people are just ordinary people, as prone to error as anyone else. I once got a notice from a collection agency, for a hospital bill I had paid the year before. It cost me an afternoon's worth of time, and a bit of gas money, but I got to the bottom of it. The hospital had migrated their data to a new server, and my account had gotten corrupted in transit, showing as in arrears.

The knucklehead of the day ... (Below threshold)
mike m:

The knucklehead of the day reward should go to Medicare and Bill Jentny for being ok with a bloated bureaucracy denying a procedure that is saving lives if you have enough money to pay for it and to me for having had this blog saved in my favorites.

While fraud does happen, mo... (Below threshold)
The brain:

While fraud does happen, most of the billing departments are completely seperate from the acutal work done, and often confuse or lose paperwork, then have to improvise to make the accounts receivable equal the accounts payable. A friend of mine spent years trying to reform the billing system at the hosptial he worked at with little sucess. The managment kept going with the lowest bidding managment company who's performance was poor, but the cost was low. I got to see the process in action when I got a 300$ reimbursement check for a 20$ copay. When I called to find out why the hospital was paying me 280$, it turned out they had credited another customer's payment to my account. If I had not said anything, the other person would have been hounded by their dept of debt collectors, even though it was the hospital accountants that screwed up.




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