A Medicare provider who listed a fictitious address, which, if it had existed, would have been located in the middle of a runway at Miami International Airport. Next come the providers and insurers that have given in to the temptation to exploit the complexity of the reimbursement system. Many of these are well- known and respected names in the industry or in their communities. Most notable in this category have been giant clinical laboratory companies that were caught adding expensive and unnecessary tests to the standard battery of tests ordered by physicians. Columbia HCA, the largest for-profit hospital chain, is currently embroiled in criminal and civil proceedings arising from allegations that it submitted falsified cost reports for certain of its hospitals and conspired to pay higher than market prices in acquiring certain home health agencies in order to reap higher reimbursement rates from Medicare.
Fraud is by no means limited to for-profit companies, however.
Briefly, a number of teaching hospitals and medical schools are being audited or are self-auditing to determine if Medicare Part B was billed for physician services actually provided by residents without proper supervision by attending physicians. Apparently, it had been EMS's practice to bill Medicare for virtually every ambulance transportation of a Medicare patient, even when the patient was ambulatory or could have used other means of transportation. These intermediaries and carriers not only process bills and pay claims, but they are supposed to be the Medicare program's first line of defense against fraudulent claims. As is the case with fraud involving their own private insurance coverages, many of these private sector plans have not only been slow to investigate and prevent fraud against the Medicare program, but in several notable cases, have themselves been accused of defrauding Medicare. Seven employees of HCSC were indicted in connection with this fraudulent scheme.