Watching TV for Mental Health: Care or Criminal Fraud? Federal Prosecutors & Defense Lawyers May Disagree
Imagine this. Mentally-handicapped people clutching coupons, staring at television reruns of Law and Order SVU: Criminal Intent and White Collar, cartoons and game shows – and not knowing they are receiving comprehensive mental health care treatment. Shades of One Flew Over The Cuckoo’s Nest? Or not?
From Attorney General Eric Holder’s perspective, Yes. “[An] alarming and unacceptable trend” – referring to the substantial rise in healthcare fraud schemes involving state and federal Medicare, Medicaid, and other insurance fraud schemes which “siphon precious taxpayer resources, drive up health care costs, jeopardize the strength of the Medicare program” and target “elderly, disabled and impoverished Americans.”
The recent, sweeping seven-city, $430-million criminal fraud takedown by the Medicare Fraud Strike Force may address this. According to officials, ninety-one health care workers – doctors, nurses, health care professionals, other people involved with health care services – allegedly participated in criminal insurance fraud schemes.
As part of this crackdown, the Department of Justice (DOJ) specifically noted an alleged criminal health care fraud scheme in Houston, TX. Seven defendants running a hospital allegedly submitted over $158 million in fraudulent claims stemming from services implemented to treat patients with severe mental illness.
Here’s how these criminal cases really go. Most of the defendants get away with a slap on the wrist in exchange for agreeing to testify against the so-called “leader organizer” – which is criminal code jargon for the passive investors/owners of clinics. In other words, the @+#*! rolls uphill. The doctors who were on percentage for providing phantom services run way with the proverbial store, while the passive owners (guilty of poor management and misguided trust) get the blame and eat the top counts . . . unless they can write a fat check to Uncle Sam.
According to Assistant Attorney General Lanny Breuer, “[mentally ill] Medicare beneficiaries [were enticed] with cigarettes, food, and coupons redeemable at the hospital’s country stores,” bribing these victims “to attend the hospital’s [Partial Hospitalization Programs].” Then the hospital’s owners and operators allegedly put these individuals in front of televisions and left them there – all the while billing Medicare for millions.
A pat scenario and words to draw sympathy. Certainly a grim depiction of alleged callous, illegal criminal enterprise – in a movie. But is it? The question arises: Beyond the alleged behavior of the hospital owners and operators, what is really up?
Medicare and Medicaid are notoriously rigid in providing and defining treatment, leaving little wiggle room for individuals and groups who sincerely want to make the world a better place. Doctors are forced to make decisions about providing treatment or forgoing it– knowing that if they prescribe certain procedures the “Obamacare” bureaucracy might dispute it as “medically unnecessary.” Rack up enough of these disputes and the feds will indict you in an effort to recoup through “restitution” everything you’ve ever collected (and in some cases everything you’ve ever billed– whether collected or not federal prosecutors call this the “Loss Amount.”
And it should be noted: Mental health care, as mandated by Medicare and Medicaid, is narrowly defined – with patients often receiving/undergoing unnecessary treatments or minimum treatment at best.
So who’s to blame . . a frustrated hospital? An anemic Medicare and Medicaid system?
Premier criminal health care fraud attorneys would like to know. Criminal insurance fraud attorneys have seen all of this before. So before the movie magic and image takes over, this white collar criminal firm will address the facts – whether it’s Medicare or Medicaid fraud, health insurance fraud, or whatever else might occur.