Have you ever wished you could be two places at once — say at work,
helping with the school play, and at the gym – all at the same time?
That would be great! But wait – what if you could talk your employer
into paying you for doing one job AND convince him that AT THE EXACT SAME
TIME you were in a different place doing a different job — so he
should pay you twice?!! What a splendid way to make double the income!
Believe it or not, some people actually think it is o.k. to charge the
Government as if they were in two places at once. The Government often
must rely on whistleblowers to warn it when people are trying to cheat
Medicare — and U.S. taxpayers.
According to a Watertown, New York newspaper article,
Feds claim Carthage Area Hospital filed fraudulent Medicare claims,The Department of Justice has sued a Syracuse, New York hospital for double
billing Medicare. According to DOJ, Carthage Area Hospital billed the
government as if patients were receiving several different services, all
at once, and at different locations around the hospital. DOJ says the
New York hospital overcharged not just once, but 1900 times!
Carthage Area Hospital, like virtually all hospitals, is a Medicare provider.
Medicare and Medicaid reimburse hospitals when they treat patients who
have coverage. The hospital sends Medicare a statement about what patient
had what treatment. To make the process easy, Medicare has set a numerical
code for every type of treatment it will reimburse.
DOJ alleges that when the hospital treated a patient, it billed for the
real treatment – say “490” for a procedure in the ambulatory
surgery center – and simultaneously billed “360,” as
if it was also treating the patient in the operating room.
Because I am a lawyer who blogs about whistleblowers trying to stop fraud,
I have written before about people who asked the government to reimburse
them for claim to be performing two jobs at the exact same time. In
Florida Oncologists Pay $3.5 Million for Medicare and Medicaid Fraud, I wrote about Florida oncologists who were accused of billing Medicare
at one clinic while they were on vacation or were working at a completely
Apparently no whistleblower was brave enough to come forward about the
fraud at Carthage, and the metaphysical billing went on for four years.
Some whistleblower missed out, because under the False Claims Act, if a
whistleblower is brave enough to come forward, he will be entitled to
between 15% and 30% of what the Government recovers. But U.S. taxpayers
really missed out, because for four years we paid for treatments that patients
were not really receiving.
Hospitals and medical clinics sometimes claim that they have a hard time
following Medicare and Medicaid fraud rules. This rule seems pretty clear
to me, though – if you treat a patient for one thing, you don’t
bill for that treatment
and also bill for an entirely different treatment. If you are operating on the patient,
you are not also giving her an eye exam at the optical center. A hospital
that is x-raying a patient is not simultaneously giving him an exam in
the audiology center. As my teenagers would put it, “Seriously?!”
If taxpayers are going to pay for that kind of fraud, we really are going
to need to hold two jobs at once!