ALICE hORNBAKER "Life After 50" ON AIR AT wmkvfm.org on INternet and 89.3 FM Cincinnati

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ALICE HORNBAKER

“Life After 50” column

ON AIR wmkvfm.org and

WMKVFM. 89.3 FM/Cincinnati

10-24-11

Hello again. This is Alice Hornbaker for WMKV 89.3 FM and wmkvfm.org streaming around the world in the Internet Mondays and Thursdays at 2:20 p.m. and Fridays at 8:50 a.m. and as a blog on growingbolder.com under blogs/life after 50/ajhornbaker. It is also on Twitter, Facebook and Linkedin.com

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Sometimes putting good money to fight fraud pays off big time.

We all hear about the various frauds crooks perpetuate against government programs, including Medicaid. There is proof now that the feds are fighting back and in this program succeeding.

Today the federal government more than tripled the amount of money recovered through efforts to stop Medicaid fraud in the past six years, government records show.

In 2004 the government prosecuted and recovered $573 million through its investigations into Medicaid fraud. Compare that to the $1.85 billion recovered in 2010, as reported by the Department of Health and Human Services.

That happened because the state Medicaid Fraud Control Units received grant money totaling $205.5 million to fight crime, compared to only 131 million before, which is a 57 percent increase in the recovery of funds. Experts are today using data analysis techniques to find medical Medicare fraud.

What types of cases are the fraud fighters seeing? One was a doctor in Pennsylvania accused of exchanging Oxyconin prescriptions for sex with one of his patients. Another case was an Atlanta doctor sentenced to prison for billing elderly—and even dead—nursing home patients for services he did not provide.

No matter how dedicated government services are there always will be those whose main focus is to fraud government programs.

So the fight also goes on in the Medicare program as well. However because the government’s oversight doesn’t follow up in many cases these crooks consistently get away with fraud.

In an Associated Press survey it found many Medicare providers have had their licenses revoked only to get them get reinstated via an appeals process, with little oversight. What happens is after a company is cited for fraud, the company appeals, and then a third party decides whether to reinstate the license. The appeal can go to an administrative law judge.

The kicker is that too often federal prosecutors rarely get to those judge hearings thus fraudulent providers tend to walk away once their licenses are revoked because the prosecutors don’t show up. The crooks simply obtain new licenses under other names and keep right on operating.

A former Miami prosecutor and fraud specialist, Ryan Stumphauzer, said in an Associated Press article that a revocation does not automatically start up a criminal investigation, which is separate process. He says Medicare doesn’t send lawyers to that first round of appeals.

So what happens? If no one from government goes to appeal hearings, the government is almost guaranteed to lose the appeal.

So what can the average Medicare recipient do to help the fraud investigators? Plenty. Every month the government sends Medicare recipients a list of charges for medical services. Seniors must read the invoice and see if it matches up to what they received. Too often there are charges there that aren’t even yours or lists of names of doctors you didn’t even see.

If that happens, immediately report it to the people listed on the report.

If enough Medicare and Medicaid recipients did this, it would give a hefty hands up to government investigators trying to recover vast sums from faulty claims.

-------------------------------------------

If you would like to reach me my email address is: ajhornbaker@yahoo.com or leave a message for me at the Cincinnati WMKV studios 782- 2427. For WMKV this is Alice Hornbaker for the Life After 50 column heard on air at 89.3 FM public radio.

ALICE HORNBAKER

“Life After 50” column

ON AIR wmkvfm.org and

WMKVFM. 89.3 FM/Cincinnati

10-17-11

Hello again. This is Alice Hornbaker for WMKV 89.3 FM and wmkvfm.org streaming around the world in the Internet Mondays and Thursdays at 2:20 p.m. and Fridays at 8:50 a.m. and as a blog on growingbolder.com under blogs/life after 50/ajhornbaker. It is also on Twitter, Facebook and Linkedin.com

------------------------------------------------------

Sometimes putting good money to fight fraud pays off big time.

We all hear about the various frauds crooks perpetuate against government programs, including Medicaid. There is proof now that the feds are fighting back and in this program succeeding.

Today the federal government more than tripled the amount of money recovered through efforts to stop Medicaid fraud in the past six years, government records show.

In 2004 the government prosecuted and recovered $573 million through its investigations into Medicaid fraud. Compare that to the $1.85 billion recovered in 2010, as reported by the Department of Health and Human Services.

That happened because the state Medicaid Fraud Control Units received grant money totaling $205.5 million to fight crime, compared to only 131 million before, which is a 57 percent increase in the recovery of funds. Experts are today using data analysis techniques to find medical Medicare fraud.

What types of cases are the fraud fighters seeing? One was a doctor in Pennsylvania accused of exchanging Oxyconin prescriptions for sex with one of his patients. Another case was an Atlanta doctor sentenced to prison for billing elderly—and even dead—nursing home patients for services he did not provide.

No matter how dedicated government services are there always will be those whose main focus is to fraud government programs.

So the fight also goes on in the Medicare program as well. However because the government’s oversight doesn’t follow up in many cases these crooks consistently get away with fraud.

In an Associated Press survey it found many Medicare providers have had their licenses revoked only to get them get reinstated via an appeals process, with little oversight. What happens is after a company is cited for fraud, the company appeals, and then a third party decides whether to reinstate the license. The appeal can go to an administrative law judge.

The kicker is that too often federal prosecutors rarely get to those judge hearings thus fraudulent providers tend to walk away once their licenses are revoked because the prosecutors don’t show up. The crooks simply obtain new licenses under other names and keep right on operating.

A former Miami prosecutor and fraud specialist, Ryan Stumphauzer, said in an Associated Press article that a revocation does not automatically start up a criminal investigation, which is separate process. He says Medicare doesn’t send lawyers to that first round of appeals.

So what happens? If no one from government goes to appeal hearings, the government is almost guaranteed to lose the appeal.

So what can the average Medicare recipient do to help the fraud investigators? Plenty. Every month the government sends Medicare recipients a list of charges for medical services. Seniors must read the invoice and see if it matches up to what they received. Too often there are charges there that aren’t even yours or lists of names of doctors you didn’t even see.

If that happens, immediately report it to the people listed on the report.

If enough Medicare and Medicaid recipients did this, it would give a hefty hand up to government investigators trying to recover vast sums from faulty claims.

-------------------------------------------

If you would like to reach me my email address is: ajhornbaker@yahoo.com or leave a message for me at the Cincinnati WMKV studios 782-

ALICE HORNBAKER

“Life After 50” column

ON AIR wmkvfm.org and

WMKVFM. 89.3 FM/Cincinnati

10-17-11

Hello again. This is Alice Hornbaker for WMKV 89.3 FM and wmkvfm.org streaming around the world in the Internet Mondays and Thursdays at 2:20 p.m. and Fridays at 8:50 a.m. and as a blog on growingbolder.com under blogs/life after 50/ajhornbaker. It is also on Twitter, Facebook and Linkedin.com

------------------------------------------------------

Sometimes putting good money to fight fraud pays off big time.

We all hear about the various frauds crooks perpetuate against government programs, including Medicaid. There is proof now that the feds are fighting back and in this program succeeding.

Today the federal government more than tripled the amount of money recovered through efforts to stop Medicaid fraud in the past six years, government records show.

In 2004 the government prosecuted and recovered $573 million through its investigations into Medicaid fraud. Compare that to the $1.85 billion recovered in 2010, as reported by the Department of Health and Human Services.

That happened because the state Medicaid Fraud Control Units received grant money totaling $205.5 million to fight crime, compared to only 131 million before, which is a 57 percent increase in the recovery of funds. Experts are today using data analysis techniques to find medical Medicare fraud.

What types of cases are the fraud fighters seeing? One was a doctor in Pennsylvania accused of exchanging Oxyconin prescriptions for sex with one of his patients. Another case was an Atlanta doctor sentenced to prison for billing elderly—and even dead—nursing home patients for services he did not provide.

No matter how dedicated government services are there always will be those whose main focus is to fraud government programs.

So the fight also goes on in the Medicare program as well. However because the government’s oversight doesn’t follow up in many cases these crooks consistently get away with fraud.

In an Associated Press survey it found many Medicare providers have had their licenses revoked only to get them get reinstated via an appeals process, with little oversight. What happens is after a company is cited for fraud, the company appeals, and then a third party decides whether to reinstate the license. The appeal can go to an administrative law judge.

The kicker is that too often federal prosecutors rarely get to those judge hearings thus fraudulent providers tend to walk away once their licenses are revoked because the prosecutors don’t show up. The crooks simply obtain new licenses under other names and keep right on operating.

A former Miami prosecutor and fraud specialist, Ryan Stumphauzer, said in an Associated Press article that a revocation does not automatically start up a criminal investigation, which is separate process. He says Medicare doesn’t send lawyers to that first round of appeals.

So what happens? If no one from government goes to appeal hearings, the government is almost guaranteed to lose the appeal.

So what can the average Medicare recipient do to help the fraud investigators? Plenty. Every month the government sends Medicare recipients a list of charges for medical services. Seniors must read the invoice and see if it matches up to what they received. Too often there are charges there that aren’t even yours or lists of names of doctors you didn’t even see.

If that happens, immediately report it to the people listed on the report.

If enough Medicare and Medicaid recipients did this, it would give a hefty hand up to government investigators trying to recover vast sums from faulty claims.

-------------------------------------------

If you would like to reach me my email address is: ajhornbaker@yahoo.com or leave a message for me at the Cincinnati WMKV studios 782- 2427. For WMKV this is Alice Hornbaker for the Life After 50 column heard on air at 89.3 FM public radio.