Health Care Fraud Means Easy Money

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Health care fraud

Health care fraud statistics were reported in a recent article in The Economist, and the story likened getting easy money from health care fraud to straight-up thievery. The report said the RAND Corporation estimates fraud in annual Medicare and Medicaid costs to be as much as $98 billion. System-wide, fraud costs amounted to nearly $272 billion.

Health care fraud involves billing for services or procedures that were never performed. It can also include having patients undergo procedures or treatments that are not necessary.

One example is the business of dialysis, which benefits from getting people into the dialysis clinic. More patients with more days on dialysis and more hours on dialysis means more money for the dialysis companies. People may receive dialysis too early or have treatments too often. Many times little thought is given to what being on dialysis means to a patient’s life, while all-out efforts are made to ensure the dialysis patient gets to the clinic three times a week–without exception.  When this happens, it is yet another instance where health care fraud can mean easy money.

This case may illustrate the point. A patient with kidney problems was told his creatinine values indicated it was about time to start dialysis. He was told by his doctor, since he was going to end up on dialysis soon, he might as well get started right away. The patient and his wife looked at each other in surprise. The doctor then walked them out of the exam room and signed him up for dialysis. Rather than telling the patient that he would likely be on dialysis soon–and should therefore take care of his affairs, take that much desired vacation, visit a relative he needed to see and, in general, live life to the fullest during the time he was still free from the 3-days-per-week regimen in a dialysis clinic–the doctor signed him up for dialysis on the spot. The patient and his wife had no time to realize what had just happened to them and what this would mean for the rest of their lives. It is very difficult to spend 3 days a week in dialysis for 3 to 4 hours each day, and still work to take care of family concerns, not to mention having the freedom to enjoy a spontaneous vacation.

The DaVita Company, one of two major dialysis businesses, has been accused of creating a cult-like atmosphere in their corporation. This “cult” in DaVita is led by Chief Executive Kent J. Thiry. It has been reported that Mr. Thiry has actually worn a Three Musketeers costume to lead employees in cheers of “All for One” and “One for All.” In a skit presented at an employee’s meeting, an employee who was dressed in a musketeer costume “killed” a federal bureaucrat, while another musketeer “killed” a federal prosecutor.

These skit scenes were undoubtedly in reference to the fact that the federal government oversees the dialysis business because federal funds cover most dialysis patients. There is a U.S. law which mandates dialysis patients have access to federal funds for dialysis treatments, and Medicare pays for almost all dialysis treatments, even for people under the age of 65.

While the cult atmosphere in the corporation has been exposed, what remains hidden and not realized is that this cult-type activity has spread into the medical community. Doctors have perpetuated the idea that kidneys do not heal, no matter what and no matter the etiology of the kidney dysfunction. It is almost impossible for a kidney patient to get a doctor to consider that they may not need dialysis forever or at the standard rate of 3 days a week. As in Chicago voting, the practice is to dialyze early and often.

Health care fraud means easy money. Cult-like mind control pressure to get people to undergo medical treatments, or to get doctors and nurses to think that they must pressure patients to accept those treatments, could be just as fraudulent as sending a bill for a procedure which was never performed.

Opinion by Margaret Lutze

The Economist
The New York Times