Billion-Dollar Band-Aids
The latest government crackdown on medical billing fraud showcases Ferraris, diamonds, luxury resorts and a yacht named 'Butt Nekkid.' But the real question is, how does this folly keep happening?
“I rob banks because that’s where the money is.” – Willie Sutton
Some medical professionals can squeeze an extraordinary amount of green from a taxpayer-funded wound – and it oozes faster than puss.
How about $1 million per patient?
Marizel Yukee, a 49-year-old nurse practitioner in Las Vegas, allegedly billed that tidy sum to Medicare per patient and our government actually paid it for years.
This is how she got her $865,000 Bulgari necklace, her $600,000 Ferrari, and an entire beach resort in the Philippines, among other trophies of the luxe life – all of it now seized by federal authorities.
Yukee and her co-conspirators allegedly submitted $906 million in claims to Medicare and other government healthcare programs. Prosecutors say she billed for medically unnecessary wound-care treatments on elderly Medicare beneficiaries, many of whom were already in hospice care.
Nearly a billion dollars billed. Nearly $300 million paid. Much of it for soon-to-be-dead bodies.
How does this happen? Call it economies of scale. Yukee was running wound care companies in California, Hawaii, Nevada and Texas, where she was finally indicted.
It’s yet another outrageous tale from our price-gouging healthcare system.
But Yukee is just one of 465 medical professionals arrested in what the Justice Department on Tuesday called one of the largest healthcare fraud takedowns in its history. We’re talking $6.5 billion in cold-hearted fraud and shameless profiteering off the sick and dying – and of course, every one of us as taxpayers.
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The biggest case in the batch involved a network that generated more than $4 billion in fraudulent claims providing amniotic wound products that were allegedly relabeled and marked up by 2,000% before being billed to Medicare.
Elsewhere, prosecutors described sprawling networks of telemedicine marketers, laboratory operators and medical suppliers who allegedly treated government healthcare programs as little more than automated cash machines. (Here’s a mind-numbing summary of all the cases.)
Then there’s a mental-health entrepreneur Daniel Robinson, 59, of Palos Park, Ill., accused of billing for behavioral health counseling and therapy services that were never provided. We’re talking over $92 million of which $75 million was paid.
Robinson loaded on luxury items, too, including an $85,000 Bentley and a yacht on Lake Michigan named “Butt Nekkid.” Now his bare ass is swinging in the wind.
It goes without saying that all of the defendants are considered innocent until proven guilty.
But I’ve been writing these tales for a long time and when I see baubles like an $865,000 necklace, or garage full of six-figure cars, stupid boats, or other ostentatious displays of wealth, I’m conditioned to suspect someone may be stealing.
Especially if they are in an industry that is supposed to be caring for people.
The problem isn’t that some medical professionals lie, cheat and steal. The problem is that we have an unchecked system that allows them get away with it – at least until some band of crusaders finally decides to sue or prosecute.
These poor Medicare miscreants could face jail time if convicted. Big companies like UnitedHealth or HCA Healthcare mostly just get sued when they’re suspected of billing fraud.
And as last year’s round-up of 324 medical billing fraudsters proves, prosecution isn’t prevention. It’s just another billion-dollar Band-Aid.
