Posted 10/21/2013 12:00 am
Senior Editor Mark Friedman’s scoop last week about a Mountain Home cardiologist, now deceased, and his Medicare fraud was monstrous in several ways. For one thing, it will be hard to beat as a monster generator of Web traffic at ArkansasBusiness.com. But much more importantly, it allowed readers to see the monstrous truth about Medicare fraud: It’s not patients, it’s providers.
Oh, no doubt there is some fraud by patients, too — some of it even without the encouragement of providers. But what patient ever ripped off the system for nearly $15 million in just 36 months, as did the late Dr. Stacey Johnson? A federal investigation into all those power chairs pitched on TV led The Scooter Store to announce last month that it had reached the end of its ramp. While nothing yet has been proven, even venerable Vanderbilt Medical Center in Nashville, Tenn., has been accused of a systematic, decade-long scheme to overbill Medicare.
In the last four years, the federal government has reportedly recovered $14.9 billion by pursuing cases of health care fraud. If the case of Stacey Johnson is a good example, it must be like shooting fish in a barrel.
Johnson, Friedman reported, had been “counseled” by Medicare for ordering excessive testing as far back as the late 1980s. Other cardiologists in Mountain Home tried to get his hospital privileges revoked. Patients complained to the Arkansas State Medical Board, and so did private insurers. But it was 2009 before his license was finally yanked for, yep, ordering a breathtaking number of unnecessary tests. And he still hadn’t been indicted by the time he died earlier this year.
Federal prosecutors have recovered only $600,000 so far. Millions upon millions could have been saved by Medicare, and by patients and their private insurers, had Johnson’s well-documented excesses been shut down years earlier.
Stacey Johnson is just one monstrous example of the factors that have pushed American health care costs to unnecessary heights.