From: unk...@googlegroups.com   
      
   "Throw Crooked Health Care Providers in Prison"   
   June 2, 2011 11:58:20 pm   
   Comments (3)   
      
   By Julia Dahl   
      
      
      
   A new book on health care fraud paints a grim picture of a crime that affects   
   us all, and usually goes undetected.   
      
   Perhaps the most chilling thing about Professor Terry Leap's new book,   
   "Phantom Billing, Fake Prescriptions and the High Cost of Medicine: Health   
   Care Fraud and What to Do About It,"  is the sheer number of different schemes   
   people in the medical    
   profession have come up with to steal money from insurance companies,   
   patients, and the government.   
      
   Such schemes range from billing for procedures that were never performed and    
   removing healthy body parts to reap the high surgery fees, to recruiting the   
   homeless to undergo unnecessary procedures and  the dilution of life-saving   
   drugs, they are    
   practices with the attitude that, as Leap writes, "Medicare will pay for it   
   all."   
      
   And that's just the beginning: "I probably could have written this book a   
   second time using completely different examples," says Leap.   
      
   Leap, whose interest in health care fraud began while he was researching a   
   book on white-collar crime in 2003, spoke with Julia Dahl of  The Crime Report   
   from his home in Knoxville, where he is the head of the Department of   
   Management at the University    
   of Tennessee, Knoxville. He wasn't optimistic about the government's prospects   
   for getting a handle on the criminal activity that resulted, according to his   
   book, in $65 billion in Medicare and Medicaid pay-outs for "questionable"   
   claims in 2009 alone.   
      
   TCR: What is the most common kind of health care fraud?   
      
   Terry Leap: I think the most common is billing Medicare for services that   
   weren't provided, or were unnecessary. Medicare is a huge target for health   
   care thieves, simply because of its size. Over the next few years we'll be   
   approaching a trillion dollar    
   budget. So there's all this cash that people can steal, and of course there   
   are so many claims, that if you don't get too greedy you could just file   
   claims that appear to be normal and no one really questions them.   
      
   TCR: Do we need new laws to help catch these people, or is the problem   
   inadequate enforcement?   
      
   TL: I don't think we need new laws. The problem is that law enforcement gives   
   most white-collar crimes  a lower priority. And I can understand why--they   
   have limited resources. I had a county prosecutor tell me that 'we settle our   
   white-collar crime    
   cases in civil court not in criminal court because we just don't have the   
   resources. We have to go after the people who murder, commit sexual assault,   
   armed robberies and that sort of thing.   
      
   TCR: And practically, it's not as easy to catch people committing crime on   
   paper, or in the operating room.   
      
   TL: Yes. One of the big differences between white-collar crimes and so-called   
   street crimes, is that with white-collar crime, detecting a crime is the hard   
   part; but once you've detected that a crime has been committed you can usually   
   figure out who did    
   it pretty quickly.   
      
   On the other hand, if you go home today and see your apartment has been   
   burglarized, you're not going to have any idea who did it. Law enforcement is   
   used to tracking down the people when they don't know who they're looking for.   
   With murder, the    
   reporting rates are probably close to 100 percent. But in white-collar crimes   
   the detection rate is much lower... because the victim has to be the one to   
   detect it and make a report.   
      
   TCR: But with a billing scam, for example, it's not that easy to detect. If I   
   come home and my TV is gone, I know it's been stolen. But if my doctor bills   
   my insurance company for something I didn't get, I might not even notice.   
      
   TL: Which is why I think that one thing that needs to be done is to educate   
   consumers. Just looking at your insurance statement to see (whether) I really   
   did get those services?--did I really get those medications?--can make a   
   difference. The problem is    
   you can't read those explanations of medical benefits very well. I don't   
   always understand what the insurance pays and what it doesn't pay. If they say   
   you got a blood test and you know you didn't get a blood test, okay...but if   
   you were in surgery, how    
   do you know? Did you get a transfusion? How much anesthesia did they use?   
      
   When my father passed away about a year and a half ago, my mother got bills   
   from doctors and other healthcare providers she knew absolutely nothing about.   
   I told her, don't pay them, wait and see. Eventually they just went away.   
      
   TCR: Last year, Eli Lilly, one of the biggest pharmaceutical companies,   
   settled with the government for more the $2 billion. That has to make a dent,   
   right?   
      
   TL: It does, but one of the problems is that federal prosecutors go after the   
   low-hanging fruit--the big pharmaceutical companies and the big hospital   
   companies that are extremely well-heeled. And they can usually get   
   out-of-court settlements that are    
   huge because they don't want to take the chance of a court decision that might   
   ban them forever from Medicare and Medicaid.   
      
   Eli Lilly recently had a $2.3 billion out of court settlement, so government   
   prosecutors can say 'look, for every dollar we spend prosecuting these   
   companies we get $15 in return.   
      
   Most health care fraud is more mundane and it's done on a much smaller level,   
   but there's a lot of it and the cumulative effect is quite large. Government   
   prosecutors don't want to "waste their time" going after somebody and   
   collecting a couple million    
   dollars when they can go after these big companies and make easy settlements   
   approaching the billion dollar range. The settlements make a dent, but I think   
   it's counter productive, because ultimately we the consumers end up paying for   
   the settlements    
   with higher prices.   
      
   TCR: And when big companies settle, it's rare that anyone actually goes to   
   jail.   
      
      
   [continued in next message]   
      
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