[shrink]

Approximately 2 years ago, I placed a post on TOTV suggesting that people avoid seeing a particular cardiologist doing business in The Villages (and elsewhere) who was performing unnecessary procedures. I described the operation, but was reluctant to disclose his name (due to liability concerns). I received several replies to this post, many of which were critical of my perceptions. Tonight on local channel 9, WFTV in Orlando, Dr. Asad Qamar was highlighted as being sued by attorney John Kroner (out of Miami) by a "whistleblower" client. The suit is a multi-million dollar one, claiming Medicare fraud and the performing of multiple unnecessary and life-threatening procedures on patients. The report stated that in 2012, (the year my husband was "treated"..who by the way, has NO cardiac condition of any kind), Dr. Qamar took in over $18,000,000 from Medicare, making him the highest paid cardiologist in the nation. My husband is still having side effects from an unnecessary cardiac cath that was performed by this "doctor". I am putting this post up for public awareness. Thank you. Be aware.

[Carla B]

I recall your former post and am happy you're finally able to reveal the name. I read the article about Dr. Qamar today in the Daily Sun and also several other sources on line. My husband was seeing one of the internists in that practice until recently, though not for cardiology.

[graciegirl]

Originally Posted by Carla B

I recall your former post and am happy you're finally able to reveal the name. I read the article about Dr. Qamar today in the Daily Sun and also the Ocala paper. My husband was using one of the internists in that practice until recently, though not for cardiology. Didn't Dr. Qamar bill Medicare $18 million in one year, rather than COLLECT $18 million? Still a huge sum.

Did I hear them say on TV news last night that he was the highest earning cardiologist in the whole country?????? Am I right on that?

[janmcn]

Dr. Qamar collected $18 million in 2012, according to the DOJ investigation, the second highest in the country. This according to the on-line news.

[Carla B]

Originally Posted by graciegirl

Did I hear them say on TV news last night that he was the highest earning cardiologist in the whole country?????? Am I right on that?

Yes, that's correct, as far as Medicare payments. The highest paid doctor at $21 million for 2012 is an ophthalmologist, also practicing in Florida.

[zonerboy]

Gotta pay for all those multi full page ads in all the local spiffy magazines somehow.

[Shimpy]

Originally Posted by shrink

Approximately 2 years ago, I placed a post on TOTV suggesting that people avoid seeing a particular cardiologist doing business in The Villages (and elsewhere) who was performing unnecessary procedures. I described the operation, but was reluctant to disclose his name (due to liability concerns). I received several replies to this post, many of which were critical of my perceptions. Tonight on local channel 9, WFTV in Orlando, Dr. Asad Qamar was highlighted as being sued by attorney John Kroner (out of Miami) by a "whistleblower" client. The suit is a multi-million dollar one, claiming Medicare fraud and the performing of multiple unnecessary and life-threatening procedures on patients. The report stated that in 2012, (the year my husband was "treated"..who by the way, has NO cardiac condition of any kind), Dr. Qamar took in over $18,000,000 from Medicare, making him the highest paid cardiologist in the nation. My husband is still having side effects from an unnecessary cardiac cath that was performed by this "doctor". I am putting this post up for public awareness. Thank you. Be aware.

Had you given his name back then maybe many people on this board could have avoided him. I understand your reason though and would have done the same thing to protect myself from lawsuit knowing how flawed our court system is.

[gerryann]

Originally Posted by Carla B

Yes, that's correct, as far as Medicare payments. The highest paid doctor at $21 million for 2012 is an ophthalmologist, also practicing in Florida.

The optomologist was Dr Salomon Melgen from West Palm. I don't believe he has practiced in the villages, but may be wrong.

[graciegirl]

Originally Posted by gerryann

The optomologist was Dr Salomon Melgen from West Palm. I don't believe he has practiced in the villages, but may be wrong.

Do these doctors come from other countries to fleece us?

[dbussone]

Originally Posted by graciegirl

Do these doctors come from other countries to fleece us?

GG - IMO, they come from different cultures. In some, ethics are not what we would wish for. I know this is not PC. The good side is that I have a couple of physicians who are not from the US, but have trained here and are absolutely first rate. On the other hand, there are others who are not.

[pbkmaine]

Some MDs and medical groups have figured out how to manipulate the system to their financial advantage. My oldest friend, an OB/GYN, absolutely hated the pressure she was under by her employer to see as many patients and do as many procedures as possible. She worked for a hospital system and reported not to another MD, but to a business type who was only interested in her "productivity metrics". She ended up taking early retirement to save her sanity. The Mayo Clinic model, which rewards MDs based on outcomes instead of "productivity metrics", is so much better. I would like to see it everywhere.

[dbussone]

Originally Posted by pbkmaine

Some MDs and medical groups have figured out how to manipulate the system to their financial advantage. My oldest friend, an OB/GYN, absolutely hated the pressure she was under by her employer to see as many patients and do as many procedures as possible. She worked for a hospital system and reported not to another MD, but to a business type who was only interested in her "productivity metrics". She ended up taking early retirement to save her sanity. The Mayo Clinic model, which rewards MDs based on outcomes instead of "productivity metrics", is so much better. I would like to see it everywhere.

Well the Mayo clinic local facilities are not what you think. They move into an area, market and establish a preliminary presence and largely recruit non-Mayo docs for the new facility. That is their model for expansion. They market their name but not what you necessarily expect.

[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….."

Health Policy Briefs

…

[shrink]

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….."

Health Policy Briefs

…

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.

[sunnyatlast]

Originally Posted by shrink

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.

Thank you. So in other words, abusers are not only allowed, but they are facilitated in running roughshod over the Medicare and Medicaid fraud detection and enforcement agents, to wreck the system for the innocent elderly and disabled--the weakest among us.

When is somebody in charge going to admit that for every fraudulent billion dollars squandered, it's a billion that did NOT get used to pay for those who need the insurance, and it's another billion that the shrinking taxpayer base will have taken out of its hide AGAIN??