WRKO>Audio & Video on Demand>>Corrine Ramey (WSJ, Health Care Fraud)

Corrine Ramey (WSJ, Health Care Fraud)

Dec 6, 2017|

Transcript - Not for consumer use. Robot overlords only. Will not be accurate.

Korean rainy from the Wall Street Journal's joining us now to talk to us about 8146. Million dollar health care fraud case in Brooklyn New York. High current. Thank you so how does one. Defraud Medicare. For a 146 million dollars. Well look if cam look operated out several storefront clinics in Brookline and and to age group of twenty people. Has this sort of organized system where it did a lid on named potential patients at places like soup kitchen and other sort of public places and offer them cash in exchange for going to one of these clinics. At the clinic they would then be given test. That we're totally unnecessary. And sometimes they would just entirely fade to the doctors. Defendants with Ben and bill for these tests billed Medicare and Medicaid. And it get money that was. OK so these people didn't have private insurance they were covered either you're indigent were they were old and had Medicare coverage act. So who was involved who was the ringleader. Don't really care who was. This woman who lived in southern Brooklyn heard it was Christine and nearby obligate conscious 35. And had very fancy taste and he used the money she netted fifteen to sort of funded those taste even brag about bad things happened bags and can't be purchased at the humane honoring mr. Graham accountant. A particular included aid to 3.2 five million dollar penthouse apartment in Brooklyn which he managed to pay for entirely in cash. In addition to anti shoes luxury bags. Those sorts of things. What day I would think you'd have to have some involvement though by medical professionals doctors nurse practitioners physician's assistants. Yes of other 24 actually doctors. And doctors are required sort of quote read the test and then signed off on them. And there's a phone call that the district attorney's office recorded. In which one of the doctors is saying that he's. Behind on fifteen housing patent. And the ringleader says she's very very matter at hand because he'd gotten so behind on his delicate work. So would do they do they pay the doctor for doing those tests. Did they paid the doctors per catch and one of the doctors who also worked as upstate New York police department department surgeon and he's since been. We suspended from the department. So how much money where the doctors making on this scale don't know. The doctors were made I'm not sure that we actually need wait. No we do not know how much the doctors made out of one equivalent to analyze it tests were paid 25 to sixty dollars per cast. That actually work would add up significantly if we're talking about you know 151000 test here. Now the doctor knew though that these were faked tests. They did the doctor certainly knew their take tests because they were actually. Not analyzing them they were just signing off on them. Oh OK now EU reference. Unnecessary examinations such as an allergy test or ultrasound. How much is an ultrasound get billed leg how much does Medicare get billed for an ultrasound or how much does Medicaid get billed for analogy test. That's a great question and I actually don't know how much they get billed. Whatever it is and it's certainly added up because at a 146 million which is that for three years. Is a huge amount of money for the Brooklyn clerk I helped her case of Brooklyn district attorney's office yesterday actually estimate that. That this game was going on before they investigated it and that there's no in more out. Well and might point would be if it's going on in Brooklyn it's probably going on in Florida probably going on in Texas is probably going on in California. It probably is. And probably it's going on and similar way. Right let's that that may explain why our health care costs are so expensive I hope they hope they do more to catch. Other operations just like this around the country Korean. So thank you very much appreciate. It discouraging it passed. Normally see these things happening in Florida. Right just because it's it's where you typically have the using the greatest concentration of people on Medicare and things like that so that's where are you on Aziz it's yet and any kind of insurance scam usually starts in Florida. But in this case one of things I found amazing was just they still haven't been able to tell all of the money that was just in this woman department. You know they they asked how much money they had there in the in the guy said she must've been planning to get away if she says it'll just cash net write it dining. Why I think that's probably how she just beat people so. You know can she can't be pay like she can't be paid with any kind of record it's traceable you can do like a wire or anything like push the money's being wired though and paid by check for Medicare and Medicaid to the doctors. Well IC but the doctors are beer than wiring it to her mountain it's it's even easier to track but I mean again you're talking about hundreds of millions of dollars here. In in pure fraud in those of you paying a 135 dollars a month for your Medicare part B nine you know why. It's like this is a head is illegal people all they don't care totally 146 million dollar flea you know what this is the only scam that's going all right you know that occurrence point this is going on with it alone on a Boston. Yeah definitely if you've got you know ten or twenty of these that are going on throughout the country which. I wouldn't find hard to believe that they are you know 221 and BO a number of major cities of Sydney talking they would get two to three billion dollars in waste the shame of it is private institutions like Aetna. Or insurance companies. They know how to protect against this that day they have systems in place the federal government running Medicare and Medicaid. They tend to get ripped off all the time because there's a just nobody's real money at stake if you're running Medicare witty candidate running Social Security we insurance companies have had their fair share of things like this is well I mean we see it all the time with auto insurance and maybe maybe they don't. Publicize it. Yeah maybe maybe you see you think it's just is rampant in the private sector as recently as a lot with like fake auto insurance claims and hands like that it's not to this deal necessarily. But it eat it still happens there's no doubt about it I don't know if it happens more or less but it happens on the private side to.