From: David Secord, DPM
I have a friend from college who is with the Federal Prosecutor’s office in Fort Smith, AR. About a decade ago, we were speaking about the length of time it takes for someone’s feet to be held to the fire after committing felonies. His response was enlightening. The DOJ has only a certain number of prosecutors and investigators upon which to rely for building and (potentially) litigating a case. He estimated that each case might entail $500,000 in costs (and that was a decade ago) and it is simply not possible for every, single instance to make it into the courtroom. There are not enough courts either.
The road you are forced to walk is to allow the potential defendant to build up a large enough number of offenses that the Feds can approach and offer a plea agreement to plead guilty to a certain number of offences, pay a certain amount in fines and surrender of assets and agree to...
Editor's note: Dr. Secord's extended-length letter can be read here.
RE: Medicare Fraud Hurts Everyone
From: Paul Kesselman, DPM
Fortunately this was not a DPM, but an almost octogenarian formulated a $1B DME fraud scheme via multiple marketing companies who managed along with cooperating patients, physicians and other suppliers to perpetrate one of the largest takedowns in the history of the CMS Fraud investigations strike force. If you wonder why the application process to obtain a DME PTAN or retain the one you have via revalidation, look no further than this report $1B Strike Force Bust.
My only question to all involved in this and previous large takedowns is WHAT TAKES YOU SO LONG and why are these investigations so expensive! If any of these people would...
Editor's note: Dr. Kesselman's extended-length letter can be read here.
RE: More Medicare Advantage Fraud
From: Name Withheld
It seems that not a month goes by without another Medicare "Advantage" Plan found to have their hands in the CMS cookie jar, having submitted fraudulent data from your patients' charts; the latest carrier being Wellcare of Florida. A recent OIG study released today found that of approximately 270 charts they submitted of high risk patients, less than 1/3 of the charts passed the OIG audit. This leaves an astonishing failure rate of over 65%.
If your practice submitted 65% of your claims fraudulently, how long would you be able to stay in practice, escape recoupment, and being fit with an orange...
Editor's note: Name Withheld's extended-length letter can be read here.
