A whisteblower lawsuit by a former employee alleges that Medicare and Medicard are being defrauded for millions of dollars by a complex three-card-monte scheme perpetrated by hospitals and group purchasing programs. [NYT] ]

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  1. Elvisisdead says:

    This is classic, and very illegal. Kickbacks aren’t illegal for goods used by private insurers, but Medicare/Medicaid will not allow kickbacks anywhere in the supply chain.

    Also, please remember that as a plaintiff in a Qui Tam suit, the woman is entitled to 25% of whatever the government recovers if they pick up her case. So, there’s no small motivation on her part here.

  2. GearheadGeek says:

    Of course, she’s only got a shot at it if the case doesn’t get swept under the rug before the current administration is out on their fat rich asses in ’09. Unless they can come up with some way to blame Clinton for it, they’ll never admit that big business is illegally profiting from government incompetence and/or corruption.

  3. mac-phisto says:

    @GearheadGeek: please RTFA. this doesn’t have to do with gov’t incompetence or corruption, it has to do with a complex billing scheme between hospitals, vendors & suppliers that resulted in medicare being overbilled for supplies.

    i have some second-hand knowledge of dmerc fraud investigations & i don’t know of any possible way that the government would have figured this one out.

  4. GearheadGeek says:

    @mac-phisto: My point had to do not with whether not not the government could/would have figured this out, but whether they’ll pursue the big-business perpetrators. I’m sure you’ve been following all the big trials of Halliburton and KBR officials for their actions in Iraq and the Gulf Coast right? All those trials? What? No trials, or even serious investigations, even though the waste and profiteering have been publicized?

  5. mac-phisto says:

    @GearheadGeek: well, it’s kind of hard to prosecute people when your evidence is hubris & handshakes. in this particular case, it appears that the hospitals are really at fault – they were receiving double payments (reimbursement from both medicare/medicaid & rebates/cash payments/stock/etc. from the supply vendors), yet it’s uncertain whether they were intentionally overbilling the gov’t. unless the prosecutors can prove collusion of some kind, it’s unlikely that this will go anywhere.