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alstry (36.04)

What % of our Economy was FRAUD

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December 14, 2008 – Comments (13)

Madoff developing.  Liar Loans exposing.  Now this???

LOS ANGELES (AP) -- A former hospital executive admitted Friday he paid a man to recruit homeless people for unnecessary medical treatment in a scheme to bilk government health programs out of millions of dollars.

Dr. Rudra Sabaratnam, who ran City of Angels Medical Center, faces up to 10 years in federal prison after pleading guilty to paying a recruiter nearly $500,000 to find Skid Row homeless people with Medi-Cal or Medicare cards and transport them to the hospital.

In his plea agreement, which remains under seal, Sabaratnam also agreed to pay more than $4.1 million in restitution to Medicare and Medi-Cal.

As  Buffett says....you see who is swimming naked when the tide goes out........

If my analysis is correct...we could become one BIG nudist colony. 

13 Comments – Post Your Own

#1) On December 14, 2008 at 11:03 AM, MarketBottom (29.25) wrote:

This is what I have been saying since 1997. I went to sleep one evening and companys were making millions. I woke up the next morning and companys were making billions. I have been saying something was bad wrong since.

Looks like it may be a Bay of Fundy tide that is leaving.

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#2) On December 14, 2008 at 12:28 PM, kdakota630 (29.72) wrote:

I saw that premise on a aTV show a while ago.  I think it was Law & Order.

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#3) On December 14, 2008 at 1:44 PM, nuf2bdangrus (< 20) wrote:

Capitalism without a social conscience is equally evil to socialism without economic freedom.

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#4) On December 14, 2008 at 3:30 PM, starbucks4ever (98.66) wrote:

Every doctor who accepts Medicaid/Medicare does the same. I can't even believe that someone would find it surprising.

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#5) On December 14, 2008 at 11:12 PM, gman444 (28.88) wrote:

Yet another nudist exposed---there will be many more, no doubt.  Hey, zlog, most who know me call me a pessimist, but even I find your statement too pessimistic.  I've been associated with the medical field all my career, and while this kind of thing is not that uncommon, "every doctor who accepts Medicaid/Medicare does the same" is way overstating it.  I would think that it is more prevalant in hospital settings, although there are private practice people who practice insurance fraud.  But there is a whole range of practitioners out there, as in any field, and a good many very competent, dedicated, and honest (remember, this statement comes from a pessimist).

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#6) On December 15, 2008 at 3:11 AM, starbucks4ever (98.66) wrote:

Then I suggest you do an experiment. Go to a dentist who accepts Medicaid and ask him to put a filling in your tooth. I assure you there will be from 2 to 4 appointments because Medicaid pays per appointment, so if you expect to be x-rayed and treated at the same day, you will be in for a...hmm, well, disappointment. A dentist who tries to work honestly will be making 2-4 times less than his competitors and will be priced out of the medical office space market because rents are set by the prices that unethical dentists are willing to pay. Every hospital visit where you pay by a free insurance card from Sammie involves some unnesassary procedure that you haven't asked for. There is no way you can refuse it. You must accept their treatment preferences or get out. 

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#7) On December 15, 2008 at 3:21 AM, jester112358 (28.84) wrote:

You may know the old saying (William Buckley I think) "the problem with communism is communism, but the problem with capitalism is capitalists".  Or to paraphrase Soros, "monetary values are not values".  Or the famous Ayn Rand tome,  "Capitalism-the unrealized ideal" (written in 1950!)  If you are raised to believe the end justifies the means, that material things will make you happy and are the most important thing etc. then all the laws in the world can't make you behave ethically.  So, the solution to our problems is better parenting especially role models for children.  Solutions must be from the bottom up, not the top down.  And this takes a lot of time and patience.

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#8) On December 16, 2008 at 11:18 AM, cbwang888 (25.51) wrote:

Financial sectors have highest percentage of fraud. I think 50%+. If you think un-justified bonus as fraud, it will be 99.9%.

You cannot see and feel what you are buying from these financial service.

Sadly, people are buying cheap stuffs from countries like China and gave their hard earned $$$ to crooks in wall street. What happened to the US working class who made real goods? They are facing layoffs and shrinking 401(k) ...

 

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#9) On December 16, 2008 at 6:52 PM, gman444 (28.88) wrote:

zloj:  With respect, there is truth in what you are saying, but you are painting with too broad a brush.  There are many providers who do not accept Medicaid, and who do not overcharge like this.  And not all Medicaid providers do this either.  The truly good providers don't have to--they are swamped with business.  If you have not come across any honest and good doctors or medically related providers, all you have to do is find one in one specialty----the good ones will know who is good in other areas, and will give you a referral if you ask for it. 

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#10) On December 16, 2008 at 7:20 PM, starbucks4ever (98.66) wrote:

gman444,

I am not saying that all doctors are bad. There are many honest doctors among the private practitioners, the ones that deal with customers directly and get paid by cash or check and get new clients through referrals, and there is a sizable share of good doctors working for hospitals. But the Medicaid/Medicare field is unfortunately full of corruption because the way this system is structured, it can't retain honest people. There's just one way you can earn any money within that system: you accept $60 per appointment and make up for it by the number of fictitios appointments you schedule. 

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#11) On December 16, 2008 at 10:13 PM, gman444 (28.88) wrote:

zloj:  Yes, it is a valid point.  There is also more red tape in the govt. system, and it takes longer to get paid.  Private practitioners who are Medicaid/Medicaire providers sometimes take on a weighted mix of govt. and private managed care to combat the problem.  The really good providers don't need to use the govt. system--some of these are idealistic enough to believe that the less advantaged, who only have M/M deserve good medical care too--they become M/M providers and tend to be honest.   The mediocre or outright bad providers who depend primarily on M/M patients often have more questionable practices.  It is strictly an anectdotal observation, but I've observed a negative correlation between competence and % of M/M patients on a provider's caseload.  It is not a perfect correlation, but high enough to be useful. 

The corruption not only stems from the structure of the M/M system, however.  Certainly it is a contributor--it is only common sense that if you low-ball highly trained professionals badly enough, you will get corruption.  But the corruption comes from every element in the healthcare system.  I've been stiffed by managed care companies, institutions, lawyers, and every segment of the population I've dealt with, including patients.  Unless you find out ahead of time what a patient's deductable and copay are, you are likely to get stiffed.  And so you must devote either considerable time, or money to hire a staff person to do this for you, and to bill, badger whatever entity you are dealing with to pay as per their agreement, etc. 

Hospitals are a little different, as billing practices are primarily handled by administrators, who often know little about medical practice.  There is usually at best an uneasy alliance between the administrators and medical staff, and at worst, outright warfare. 

But you can't let physicans and other medical professionals off the hook either---the managed care system stemmed from the excesses of physicians, and was more than anything, a transfer of power.   So the corruption is really like a virus, that just moves around and finds the cracks in the system, like water flowing to the cracks in a sidewalk...

I have seen providers trying to get established use the problem to their advantage as well---eg, falsely accusing a competitor of Medicaid fraud--a mandatory investigation follows, tarnishing the competitor's name, regardless of the outcome.

Most practitioners cannot survive on a cash-only practice--this is by far the best way to go, but takes a good deal of time, interface with the community, networking, etc.  Particularly important is becoming proficient and established in a particular niche area that is valued by the community.  There are few private practice people who can survive this way, but those that do, do very well.  Again, while some of these are very good indeed, some are not much good at anything except self-promotion; but this note is getting long, and I will end here, for now....

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#12) On December 16, 2008 at 10:47 PM, Zeofar (< 20) wrote:

That isn't even to mention what some patients get to feel - nowadays some doctors are giving poor treatment to patients with public health insurance for the kind of "job security" that everyone expects from automobile mechanics; either that or they like people suffering. In any case, if ethics and morals don't return in the U.S.A., then things are going to be getting ugly.

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#13) On December 17, 2008 at 2:49 PM, gman444 (28.88) wrote:

Zeofar:  Yes, the patients, who the system is supposed to be serving get lost in the shuffle.  I'm afraid it already is quite ugly, and getting worse.  It is amazing to me the number of people who think of medical care strictly from a business model perspective--when your life depends on getting competent medical care, I don't think you will be focusing on the business model involved.   The patients are always the ones to suffer most when the system doesn't work right......

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