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Originally Posted by Challenger
I know for a fact the names of three doctors who have been found guilty of Medicare fraud who are now practicing in TV. They have all movde here from other communities where their misdeeds started .
Always Google any new provider. Try yours now , some of you will be quite shocked.
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And here is the law regarding Medicare fraud and ongoing participation in Medicare / Medicaid
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Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.
The effect of an exclusion is that no payment will be made by any Federal health care program for any items or services furnished, ordered or prescribed by an excluded individual or entity. No program payment will be made for anything that an excluded person furnishes, orders, or prescribes. This payment prohibition applies to the excluded person, anyone who employs or contracts with the excluded person, any hospital or other provider for which the excluded person provides services, and anyone else. The exclusion applies regardless of who submits the claims and applies to all administrative and management services furnished by the excluded person.
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There is no misinterpretation of that requirement. A person subsequent to such penalty does have the option to appeal for reinstatement. I have no idea about the typical length of the exclusion but believe it is related to the severity of the fraud. Nor do I have data on how often a request for reinstatement is granted. However, I would ask that the names of persons who are excluded from Medicare who are now practicing in the Villages, as alleged, be given to us. Fraud is a major concern and if there are practitioners practicing here who have been prohibited from Medicare participation, neither they, nor their group practice, nor their hospital can bill for that provider's services. Who are these three doctors who you know as a fact to have been found guilty of Medicare fraud? There is no concern for liability in giving us those names as truth is a defense against libel. Additionally all suspensions from Medicare as well as convictions for fraud are already public record. You may post links to the stories of their convictions if you decline to name these fraudsters yourself.
The recently enacted ACA (Obamacare) has a provision increasing the budget for detecting and prosecuting Medicare fraud. I hope (opinion) it is very successful. If you have a doctor who is waiving your Medicare copay, that may be fraud. If you are getting billed for a test you didn't need or even worse never had done, that may be fraud. Sometimes someone just clicks in the wrong place on a superbill so not all errors are fraud, but all need to be reported to clean up the problem.
Reporting fraud | Medicare.gov