Avoid and Report Health Care Fraud Investigation

Healthcare is a very big complex industry in the world. Nowadays, healthcare fraud is a very sensitive issue in all parts of the world.  It involves doctors, health care practitioners and fake medical supply companies that overcharge and send in false billing invoices to Medicare for services and the products that have never been provided to the patient. Those are from other professions who do the same.

Any type of misrepresentation in health care benefits is regarded as a criminal activity. Timely active icfeci health care fraud investigation defense is required to handle such a situation. Which situations may be regarded as criminal charges?  Here is a look at a few examples.

•    Showing false medical bills

•    False procedure to get coverage under the non-covered medical treatments

•    Showing false medical insurances

Dishonest health care providers mainly commit major health care fraud. Health care fraud is a crime which is not roaming around only to the healthcare provider level but there are other major contributors like patients, taxpayers, employers, insurance plan sponsors, and healthcare vendors also. The insurance prices rise due to healthcare fraud. For every claim insurance companies pay that are fraudulent we pay higher premiums. It may not be fair but this is exactly what happens. The premiums are raised so that companies can recuperate money that has been paid out to those who shouldn't have received it, to begin with. This has a big negative impact on low-income people.

Health care fraud has an even bigger effect on our life. Not only do your tax dollars pay for this but it means that care may be taken away from those who deserve it and are in desperate need. Imagine children not being able to receive the care they need because an adult is getting free care simply because they don't want to work.

This type of fraud also leads to stricter policies and regulations. Medicine that is needed may not be available to some people because of a select few cases of abuse it. Pain medicine is the most widely regulated due to people with addictions. This, in turn, means that some people may suffer in pain due to not being able to get the proper medications. Of course, it isn't just limited to individuals. Doctors and hospitals are involved as well. Some may submit bills for services they didn't provide. Some doctors and hospitals have even gone as far as to create ghost patients. Often times this could be as simple as performing procedures that are not necessary.

The successful health care fraud investigation will result in the collection identify and collect all relevant evidence that would indicate the laws, rules and/or regulations governing health care have been violated, and to identify storytellers who will be able to testify on matters relevant to the identified misconduct. The patient file is the crime scene when investigating health care fraud & abuse.

At ICFECI, we do healthcare fraud investigation of the cases relating to false billing, offering health care services without a license, false insurance claims, false diagnoses, and unauthorized surgery, kickbacks inpatient referrals, Medicare/Medicaid billing schemes. For more information, contact us @ 214-384-3246.

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THEN THEY CAME FOR ME

As a criminal investigator, I am sometimes called on to piece together the stories of those who cannot speak for themselves—the very young and the very old. I believe in the sanctity of life. A recent spate of cases I’ve worked, combined with an uptick in news coverage for these kinds of cases, has me worried. I wonder, are we heading down a slippery slope that will take us back in time to the dark days of the Holocaust?

The inevitable question that is asked in abuse, neglect and death cases of the very young and very old is HOW CAN THIS HAPPEN?

The Holocaust Museum, in Washington DC is a haunting and often disturbing look back in history. It’s a physical place that endeavors to answer the question with relics and artifacts. It does so much more. It challenges us to look at ourselves.

First, it’s important to understand that the slippery slope I mentioned above doesn’t start with a widespread killing mechanism. The Nazis started with sorting humanity in Germany and growing those programs in the countries that were subsequently conquered. At first there were simple charts, genealogy in nature. Your life had value if you could “prove” your “purity.” Next came medical examinations of hair and eye color. Something as common as brown eyes, or dark hair could lower your status.

The Nazis then determined who could serve in the military, and that was mandatory. The non-pure were sorted into two groups: those who could work, and those who could not. Those who could not work, included the elderly, sick and disabled.  The year was 1939, the program was dubbed  “T4”. And ultimately 90,000 disabled where euthanized. A mere 80 years ago.

From that point, the killing machine was in full force.  We know the end of the story.  The “Final Solution” ultimately killed 11,000,000 people.  Of course we know the tragic plight of the Jews , estimated at 6,000,000 deaths.  But the killing spread from the disabled, and very young, Jews, then Roma “gypsies”, homosexuals, Jehovah’s Witnesses, ex-convicts, and others who resisted occupation (political dissidents).  Add in the Soviet prisoners of war, and the number exceeds a staggering 17,000,000. And, remember, it started with “mercy killings” of the disabled. (The Nazis even produced a propaganda film in which a German man kills his sick wife to encourage ordinary people to join the “cleaning” of the German race.)

A growing number of countries, including the US, have legalized assisted suicide. Although on the surface it seems reasonable to allow people who suffer from physical pain and diminished quality of life to end their lives, there is a recent shift in the “right to die” movement.  People with treatable and manageable conditions such as depression are making petitions to die. Some European countries have dealt with cases of rapists and murderers who want to die rather than face prison.

 Here in the US, we face some troubling realities.  We are living longer. Our elderly are covered by Medicare, and this government insurance program approves and declines medical procedures on our aging population. Two startling statistics arise in consideration of care: 1) 5% of patients at the end of life consume 50% of the costs for Medicare, and 2) in the last 6 months of life, it’s estimated almost 30% of a person’s lifetime healthcare costs are spent. Are we at the point where cost considerations are the slippery slope I’ve mentioned?

I’m concerned also about so-called partial birth procedures. At what point do those go from voluntary  and used to spare a mother’s life to compulsory? I can see in the not-so-distant-future when, again, costs could mandate these lives aren’t cost effective.

It’s easy to say, I’m young and healthy. My insurance wouldn’t do that. The US appears to be moving to “Medicare for All.” If, and when, we become a single payer system, will all life be valued and protected? Or will we begin sorting ourselves?

German pastor Martin Niemoller wrote a poem called “First they came…”  It’s been edited and changed over the years, and originally was written to criticize the German intellectuals who did nothing as the Nazis began purging unwanted populations.

“First they came for the socialists, and I did not speak out—Because I am not a socialist.

Then they came for the trade unionists, and I did not speak out—Because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.”

Now, replace the words I bolded, with words that describe yourself, your friends, your religion, your politics, your race, etc. It’s a haunting reminder from just the last century.  Let’s never look back on our society and ask, “HOW DID THIS HAPPEN?”

I’m hopeful we can live in such a way that respects life. All we need do is live by the “do unto others” mantra, and vote for those representatives that will continue our collective respect for life. We must hold each other accountable for the least among us. I’ve already chosen to take a stand for the weak and broken in society. I’m hopeful you will stand with me.

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