Medicaid scams said to cost billions
When an unusual number of pregnant Filipino women were found to be flying to New York and California — and flying back home with newborns in tow — state officials decided to look into this suspicious baby boom. They discovered that dozens of Philippine Airlines employees were having their babies at American hospitals, with American taxpayers footing the bill via Medicaid.
Claiming to be destitute, scores of foreign visitors are coming to the United States for free Medicaid care (one Russian tourist had two liver transplants, racking up $500,000 in hospital bills). That’s just one of the Medicaid scams robbing taxpayers of billions each year, Reader’s Digest magazine reported in its August 1999 issue.
Medicaid’s annual budget, slightly over $1 billion after Congress established the program in 1965, has exploded to nearly $200 billion this year. Investigators blame fraud and abuse for about 10% of that total, or almost $20 billion.
Con artists have learned how easy it is to be enrolled as a Medicaid "provider," and just how little verification claims receive before they are whisked through to payment. Reader’s Digest blueprints some of the scams:
• Medicaid mills. Corrupt clinics work overtime cranking out claims for fictitious or duplicate patients. One New York City radiologist collected $1.7 million in just over two years for reviewing 24,000 unnecessary, duplicate, or phony tests delivered weekly in shopping bags by accomplices at local clinics.
• Transport scams. Driving patients to and from the doctor is a lucrative business, especially if you don’t even have to start the ignition. One Florida dispatcher used her access to patient names to forge phony trip tickets, then sold them by the bundle to company cabbies. Palm Beach County Medicaid costs soared by $10 million before the ring was busted.
In California’s latest scam, van drivers tote farm-worker families to Los Angeles-area clinics, where doctors use the laborers’ Medicaid ID numbers to charge a variety of phony services. The drivers get a kickback; the "patients" get a meal and a pair of shoes.
To root out rip-offs, reformers told the Reader’s Digest writer that:
• States must make better use of new computer search tools.
• More grand juries must be impaneled to target Medicaid cheats.
• Medicaid systems should send recipients and providers explanations of services paid, so honest individuals can help spot fraudulent billing.
• The Health Care Financing Administration (HCFA) should bring government agencies together to identify foreigners visiting the United States to obtain Medicaid benefits. In the past, HCFA has hindered states from collaborating with the federal government on this issue, claiming patient confidentiality was being threatened.
(Editor’s note: For additional information, visit www.readersdigest.com.)
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