Quote:
Originally Posted by sunnyatlast
Q: Why has this "Dr." Qamar billed and abused our tax-funded Medicare system like a charlatan?
A: Because he COULD.
CMS has known for a long time what this guy was/is doing. And there are many other crooks billing Medicare just like he does across across the country.
The magnitude of this abuse of taxpayer-funded public health insurance is so huge that to me, it is absurd to want this same monstrous type of system across the board for everyone to be under a government single payer system!
Consider:
"The true annual cost of fraud and abuse in health care is not known. In fiscal year 2011 Medicare spent $565 billion on behalf of its 48.7 million beneficiaries, while federal and state Medicaid agencies served 70 million people at a combined cost of $428 billion. CMS estimated that in fiscal year 2010 these two programs made more than $65 billion in "improper federal payments," defined as payments that should not have been made or were made in an incorrect amount. Adding in improper payments made by state Medicaid programs boosts the total by about $10 billion annually.
UNDERSTANDING THE PROBLEM: CMS's estimate of improper payments, which relies on random samples of claims data, is widely thought to understate the true size of the problem of fraud and abuse. In an April 2012 study former CMS administrator Donald M. Berwick and RAND Corporation analyst Andrew D. Hackbarth estimated that fraud and abuse added as much as $98 billion to Medicare and Medicaid spending in 2011.
For many years, the Government Accountability Office (GAO), the investigative arm of Congress, has designated Medicare and Medicaid as being at "high risk" for fraud, abuse, and improper payments. Both programs were designed to enroll "any willing provider" and to reimburse claims quickly for services provided.
The programs today handle an enormous volume of transactions, making it easier for dubious claims to escape detection. Every business day, for example, Medicare administrative contractors process about 4.5 million claims from 1.5 million providers. Every month, they process 30,000 enrollment applications from health care providers and suppliers of medical equipment.
The emphasis on rapid payment, as opposed to identifying and rooting out false or inflated claims, makes both programs susceptible to fraud. Taking advantage of this weakness, for example, Eastern European crime syndicates have lately become prevalent players in Medicare fraud, specializing in stealing the identifies of Medicare and Medicaid beneficiaries, and then billing the programs for treatments that didn't take place at clinics that don't exist.
The magnitude of potential wrongdoing is such that resource-strapped federal prosecutors have adopted an unofficial threshold that requires that alleged crimes be worth at least $500,000 and be clear cut enough to make conviction a near certainty before they will take up a case. That leaves a lot of room for marginal operators to game the system for many multiples of much smaller sums….."
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I believe you are 100% correct about everything you had to say. For one thing, I submitted a fraud claim against Dr. Qamar in 2012. I noticed on my Medicare statement that Qamar had billed for both a treadmill and a chemical stress test. I never had a treadmill test (nor was I offered one, as the chemical stress test was far more lucrative for the practice). The Medicare Fraud rep with whom I spoke told me that I might not be informed of the status of my complaint, as there was already an ongoing investigation of this practice! What??? To make matters worse, apparently some years ago, Dr. Qamar was under investigation by Medicare, with the concerns being "founded". None the less, he was allowed to continue to practice and to bilk the system of multiple millions of dollars, not to mention the harm he did to perhaps thousands of patients who underwent unnecessary procedures. When I tried to talk with the Medicare rep about the unnecessary procedures (as spelled out by our second opinion cardiologist), I was told there was "nothing that Medicare could do about the tests that a licensed physician chooses to order", and that the only report that they could file was if a procedure was billed that hadn't actually been done!
On another note in reference to your post, up North, the husband of my closest friend is an ER doctor in a mid-sized community hospital. He has been brought in on the carpet (and in fact, threatened with loss of employment) because he was judged to be too thorough, and thus, not turning patients over fast enough. Because the hospital is urban, many of the patients who come in are drug seeking. My friend's husband was told repeatedly not to waste time checking the drug registries, but to give the patients a short supply of narcotics and get them out of there. I realize this is an entirely different scenerio from the Qamar deal, but reflects some of the pressures that undermine a functional health care system.