After uprooting the current fraudsters, the solution is a simple fine print change in the medicare medicaid statute. In today's world anyone can start a medical supply house and the next day register with Medicaid and Medicare. With a list of patients, including their social security numbers, those obtained by either corrupting someone who works in a Dr.'s office, and purchasing the patient list from them, or stealing the information via computer hack, the fraud begins.
For the thief, this is cake. Generate a fake prescription for a prosthetic arm or leg, as was shown in a 60 Minutes documentary, fill out the Medicare or Medicaid form for services rendered and the government computer spits out a direct deposit into your medical supply house bank account.
It does not require rocket science to recognize fake medical supply houses are the window for billions of dollars in fraudulent billings. Step one to eliminating the fraud is obtaining the list of names and addresses and zip codes of all registered medical supply houses doing business with Medicare and Medicaid. Add to that the list of medical professionals, their names, addresses and zip codes whose prescriptions end up in the hands of the medical supply houses. The final list are the patients whose scripts are being filled.
For example, a patient might travel five miles east to their physician's office, but an additional seven miles farther down the road to a medical supply house, to fill the prescription for the latest radar equipped oak plated cane? I doubt it.
With all the computer flagged transactions in hand, every House of Representative member's staff could put a friendly government call through to all of the med-supply houses in their districts.
These so-called med-supply houses are supposedly dealing with the public, so the failure to answer the phone, or return a call is reason enough to freeze their Medicare Medicaid account and immediately contact FBI to touch base with the fake medical supply house's depository bank to also put a temporary freeze on all withdrawals from that bank account, too.
There are legitimate medical supply houses that are one product operations. For example, a company fills prescriptions for a portable machine with electric nodes to massage back muscles. A doctor writes the prescription for the machine, and the company supplies their machine, and accessories to patients all over the country. They are a genuine company and always answer their telephone.
With a computer data base program an undergraduate computer science major could write, within two weeks every fraudulent medical supply house will be exposed, their bank accounts frozen, their doors closed, and the prevaricators running for cover. Legitimate companies, accidentally caught in this mill can easily prove they are on the up and up because they have actual genuine records of goods and services provided that can be verified.
The long term solution is common sense change in the statute, disallowing "new" medical supply houses from doing business directly with Medicare and Medicaid.
Excepting single product medical supply houses that distribute their single product across state lines, all prescriptions must be personally presented by the patient to a bricks and motor pharmacy in the same zip code, or at most, one zip code away from the patient's residence, or the doctor's office.
The place where you generally purchase your pharmaceuticals is the place where you fill the prescription for your new prosthetic pinky toe. Of course there are exceptions. Someone bed ridden might give their ID, with their Medicare or Medicaid card to their care giver to go to the pharmacy on their behalf.
Under current law, anyone can claim they are a medical supply house, register for services rendered reimbursement from medicare and medicaid, submit fake prescriptions and syphon the tax payer's dollars 24 / 7.
Every Congressional office in Washington can have their DC staffs phoning every supply house in their districts. Someone in the Congressperson's district office can hop in their car and drive over to see is there actually more than a P.O. box for the fake company whose address is an empty lot.
Within ten working days a yearly 50 billion dollar fraudulent drain on Medicare and Medicaid will be plugged. Bureaucracies are alien, the only creatures on good ship mother earth that feed on themselves and multiply.
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