Lisa Trigg, writing for the Terre Haute Tribune Star, has a story reporting on charges against a Terre Haute pharmacist charged with committing fraud to the tune of $3.5 million. Apparently he would initiate a prescription that would be billed to Indiana Medicaid, then void the prescription before the system processed it in a way that would make it evident to other people working at the pharmacy that prescriptions were going unfilled. If the charges are true, it looks like this pharmacy billed Indiana Medicaid for $8 million, only about 56% of which was legitimate.
As part of the investigation, federal authorities seized five Harley Davidson motorcycles, a Corvette sports car, a Mustang sports car, four sport utility vehicles, an all-terrain vehicle and trailer, two pickup trucks, and more than $261,000 in funds from multiple bank accounts.
So, it doesn’t look like the guy was stealing just because he was in over his head on a mortgage or something. He liked his toys.
I think part of the reason I like seeing this kind of crime being prosecuted is that it makes me feel like less of a chump for keeping my nose to the grindstone and my recreational pursuits modest.
You’re missing the point. This guy is not unusual. Medicare and Medicaid fraud are hard to estimate because the systems are so chaotic and not managed very well. In fact, the fatal flaw with these programs is the way they are set up at their most basic level: fee for service. You go to the doctor, he performs a procedure (no one checks to make sure the procedure is legitimate), and Medicare/ Medicaid pays.
Liberals like to boast about the low administrative costs of these programs, but the flip side is that they manage nothing. Fraud on a massive scale is the result.
Every once in a while a guy like this is caught, and you can get a glimpse of what is going on.
It’s not “fee for service” that’s the root problem (“fatal flaw” as you call it). After all, fee for service is a concept embedded in voluntary transactions in a free and (hopefully competitive) markets.
No, the root of the problem is everyone in these programs walking around with a card in their pocket, a card that more often that we care to admit has more value to an array of service providers (docs, hospitals, pharmacists, etc.) than to those who carry it around.
In short, using the card is costless to who the card is registered to, but can be a goldmine to providers who can ‘sell’ their services to them. Alas, selling those services is not to hard — after all, they’re virtually free to the consumer.
As long as the consumer doesn’t protect his card like he does his own money, then we’ll continue to read stories like this. And with Obamacare, I strongly suspect we’ve not seen the end of this same dynamic.
A friend of mine pointed out that this probably means that a lot of people were getting EOBs from Medicaid listing prescriptions they never received and nobody said ‘boo.’
I watched Sicko about a year or two ago and at least one country that provides health care to all of their citizens does not use a fee system. Doctors are paid based something along the line of how many patients they serve and not on the individual services provided.
in another country “doctors are paid […] along the line of how many patients they serve and not on the individual services provided”
Can you think of how that system can be abused? (I’ll give you three seconds… )
Remember, this case was about services NOT provided….