Matt Gruber said:
an 88 yr old man got 2 hip replacements on medicare.
perfectly legit.
lets say it cost $180,000
new idea:
offer him the OPTION of 2 new joints OR a cash payment of, say, 60,000 and a wheelchair.
This could save $$$$$$$
the guy could use the $$$$$
to, say, send a grandchild to college, hire a hooker, or send his hooker to college!
.
Good idea?
How about an employer plan with a lower limit, and pay the cash savings to the employee?
Let's say Joe works at XYZ and has an unlimited plan. Offer Joe the OPTION of $$$$$$ extra cash every year, if he accepts, say, a $1 million cap and a 20% co-pay.
Now Joe has an incentive to keep his expenses down and gets cash now.
Good idea?
.
BAN FREE SERVICE
this alone could rein in costs. EVERYBODY has a co-pay. Even the poorest of poor pay 1%.
a sliding scale up to 100% for the Forbes 500 richest.
Everyone will think long and hard, ...... is a new knee at 75 worth the co-pay? many will say NO.
Good idea?
I bet this already goes on, but what happens is people scam the system. I did a quick goggle search and came up with this.
Also if people were paid not to get a procedure, people would be coming out of the woodwork claiming they needed something done, just so they can get paid not to get it done.
(PressZoom) - HOUSTONâ€â€The owner of City Nursing Services of Texas Inc., an alleged Houston physical therapy clinic, has been indicted for conspiring to commit health care fraud, health care fraud, mail fraud and money laundering arising from an alleged multi-million dollar health care fraud scheme, United States Attorney Tim Johnson and Texas Attorney General Greg Abbott announced today. The 36-count indictment was returned by a federal grand jury this morning.
Umawa Oke Imo, 54, a permanent resident alien in the U.S. and native of the Federal Republic of Nigeria, was taken into federal custody on Friday June 26, 2009, following the filing of a criminal complaint which accused him of health care fraud. He has remained in court-ordered custody without bond since his arrest.
Imo is accused Imo of filing approximately $42 million worth of claims, predominantly for physical therapy services which were not performed at City Nursing, not performed by a licensed physical therapist and not performed by an appropriately supervised physical therapy assistant, with Medicare and Medicaid between Jan. 1, 2007, through April 30, 2009. Approximately $30 million was paid by Medicare and Medicaid for these claims. According to indictment, Imo did not hire any licensed physical therapist to work at the clinic and did not have licensed physical therapy aides appropriately supervised. Imo allegedly paid Medicare and Medicaid beneficiaries approximately $100 to sign multiple blank forms indicating they received physical therapy when no such services were provided. Some beneficiaries reportedly received additional payments for not complaining to authorities. Imo also allegedly paid marketers for bringing beneficiaries to the clinic. The mail fraud charges center around three paper checks valued at approximately $180,448 that were mailed by the Medicaid contract administrator as payments to City Nursing in lieu of electronic fund deposits between March and May 2008.
Imo is also charged with money laundering and is accused of engaging in five transactions occurring between April 2008 and March 2009, each more than $10,000 and totaling $2,805,195 from a City Nursing bank account for referrals, the purchase and shipping of tankers to Lagos, Nigeria, and a check for more than $1 million payable to Imo himself.
The investigation leading to the charges is the result of a joint investigation conducted by agents from the FBI, the Texas Attorney General's Medicaid Fraud Control Unit, Internal Revenue Service - Criminal Investigation Division and U.S. Department of Health and Human Services - Office of Inspector General.
If convicted of health care fraud, conspiracy to commit health care fraud and money laundering, Imo faces up to 10 years in prison and a $250,000 fine. The mail fraud carries a sentence of up to 20 years in prison. Special Assistant United States Attorney Julie Redlinger is prosecuting the case.
A indictment is a formal accusation of criminal conduct, not evidence.
A defendant is presumed innocent unless and until convicted through due process of law.
Deron.