Health Care Claims Fraud

It's illegal to submit a false claim form to an insurance company in order to
be paid for health care services which were not received or provided, but it is
done frequently and is difficult to prove since the insured generally has no
idea what services his/her doctor has billed the insurance company for. Doctors
are billing insurance companies for services that were never performed and
often double billing and over charging for what little service may have been
provided to the patient.Yet, it is always the insured who is publically faulted
for the high costs of medical care.

Example of documented case:
A patient went to the emergency care unit of a local hospital with intestinal
problems that seemed severe. The attending physician called the patient's
family doctor and described the patient's symptoms and was told to admit the
person seeking aid. That was the extent of the family doctor's participation
that evening. The patient was actually seen by his family doctor the following
morning in the hospital. The doctor billed the insurance company for $135.00
for the call admitting the patient and $85.00 for the next day's visit in the
hospital.

The insurance company paid both charges without a challenge. When the patient
questioned the $ 135.00 phone call, he was told that it was the customary
charge for admitting a patient of his.

That seems a bit unfair for both the insurance company and the patient.
However, since the patient was not obligated to pay any part of the bill,
nothing was said or done about the apparent excessive charge.

Is it no wonder why health care is under criticism in America?

Generally, if a person has health coverage, and ends up not having to pay for
medical services out of their own pocket, they don't care what the insurance
company is charged by the provider. The result - the insurace company may be
gouged by the medicine man/.woman..

This is a violation of the New Jersey Health Care Claims Fraud Act, N.J.S.A.
2C:21-4.2 and 2C:21-4.3.

Punishable by 5 to 10 years in prison if the person is a doctor, chiropractor,
dentist, psychologist, nurse, pharmacist, physical therapist, lawyer or other
licensed professional and the claim is submitted for providing professional
services.
In addition, this person can be required to pay a fine of up to $150,000 or up
to five times the amount of the claim.
A person who is not a doctor, chiropractor, etc., could be sentenced to 3 to 5
years in jail for filing just one false claim!

Medicaid Fraud

It's illegal to participate in a scheme to offer or receive kickbacks in
connection with the furnishing of items or services which are billable to the
Medicaid program.

It's illegal to over bill Medicaid for services provided.

It's illegal to receive more Medicaid benefits than you're entitled to.

These are violations of N.J.S.A. 30:4D-17.

Punishable by up to 3 years in prison and a $10,000 penalty.
They may also be violations of the Health Care Claims Fraud Act and other
criminal statutes!

Could Doctors Ever Be Gods Again?! (Part 3)
Corruption and Remedy:

by Dr. S Selvakumaran, Erode

Somewhere in the history of mankind it had come to be understood that the
medical profession poured tons and tons of money to its practitioners and thus
began an end-less and a thoroughly competitive race of becoming a highly
qualified doctor at whatever cost it involved. Politicians made good use of
this human appetite and endeavor and thus came a point when medical education
became a huge financial burden and commitment upon all those that pursued it.
Thus the ball of corruption was set in motion. Quality of medical education
took a severe beating with it.

It is extremely pathetic to gather, that the only defence currently available
with the public, against this organized assault being systematically unleashed
by the community of doctors against them, is plain-honest-disorganized anger.

Remedy:
SEE:
Could Doctors Ever Be Gods Again?! (Part 3) - Corruption and ...  - ... being
systematically unleashed by the community of doctors ... shall be on the
"already corrupted medical force ... the powers vested within it to eliminate
corruption. ...
http://antidoctor.crimsonzine.com/20031112-9094.html  

Gangsters In Medicine  - Rense.com Gangsters In Medicine By Thomas Smith
Valley@healingmatters.com. c. 2002-3 By Thomas Smith All rights reserved
12-23-2 ...
http://www.rense.com/general33/gang.htm

Medical Misdiagnosis:
Challenging the Malpractice Claims
of the Doctors' Lobby
Executive Summary
January 9, 2003

The major findings in this report are the following:

Doctors’ Attacks on the Tort System Are a Misdiagnosis that Diverts Attention
from an Epidemic of Medical Errors and Unsafe Practices

Between 44,000 to 98,000 Americans die in hospitals each year due to
preventable medical errors, according to the Institute of Medicine (IOM). By
comparison, the annual death toll is 43,000 from automobile accidents, 42,000
from breast cancer, and 15,000 from AIDS.

The costs of doctor negligence and the medical liability system is much greater
for patients than doctors. The IOM estimates the annual costs to society for
medical errors in hospitals at $17 billion to $29 billion. These costs include
disability and health care costs, lost income, lost household production and
the personal costs of care. They do not include medical malpractice occurring
outside the hospital setting. By contrast, the National Association of
Insurance Commissioners reports that the total amount spent on medical
malpractice insurance in 2000 was $6.4 billion – at least three to five times
less than the costs of malpractice to society.

MORE:
Public Citizen | Congress Watch | Congress Watch - Medical ...  - Medical
Misdiagnosis: Challenging the Malpractice Claims of the Doctors' Lobby.
Executive Summary January 9, 2003. The major findings ...
http://www.njccj.org/medicalmalpractice/articles.htm

The Bush administration is poised to restructure tax breaks for ...  - ... 12
“Medical Misdiagnosis: Challenging the Malpractice Claims of the Doctors’
Lobby,” Public Citizen, Washington, DC, January 2003, p. 15, available at ...

http://www.tcf.org/Publications/healthcare/medicalmalpractice.pdf

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