Health and Human Services Inspector General Daniel Levinson said the public should be “outraged” to hear that government warnings to avoid using the anti-psychotic drugs on people in nursing homes with dementia often went unheeded. He went on to accuse manufacturers of “putting profits before safety” by aggressively marketing these drugs for just such uses.
An audit in 2011 found that almost 305,000 of over 2 million elderly persons who lived in nursing homes in the first six months of 2007 had a prescription for at least one atypical anti-psychotic drug.
The OIG report said that 88 percent of these prescriptions were written “off-label,” meaning the drugs were being used for purposes that had not been approved by the Food and Drug Administration. In some cases, pills were prescribed despite warnings from the FDA that using them for treating dementia patients could be dangerous. In all, unapproved uses and improperly documented claims for these drugs cost Medicare $116 million in one six-month period, the report found.
But the Inspector General's investigative unit, citing major budget and staffing cuts, is scrapping new audits to identify the problems in nursing homes. (Big pharma wins again. Old people, with no one else to care for them, lose.)
Also, in other related medical fraud news: hospitals grab at least $1 billion in extra fees for emergency room visits, suggesting facilities have taken advantage of government’s failure to set billing standards. The growth of electronic medical records has helped ease the path to inflate medical bills as billing software helps medical professionals document higher fees.
According the Center for Public Integrity, U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder fired off a stern letter to five prominent medical groups threatening criminal prosecution for applying the technology to bill for more complex and costly services than merited --- a practice is known as “upcoding.”
Doctors and hospitals have collected billions in questionable Medicare fees. One investigation suggests costs from upcoding and other abuses is massive fraud. Thousands of doctors and other medical professionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade — adding $11 billion or more to their fees and signaling a possible rise in medical billing abuse. (The GOP wants to cut Medicare insurance for elderly patients, rather than investigate the corporate fraud.)
Average working Americans are paying for corporate fraud. As the decades have gone by, Americans have been spending more and more on health care, largely through their health insurance premiums, to the point that many families cannot afford the kinds of health insurance plans in which middle- and upper-income families take part.
Working Americans are paying for corporate fraud in the way of jobs as well. In looking at the totality of the Affordable Care Act, the most important component of the act is what it will do to the costs of medical care. For the last 25 years (according to a study from the National Federation of Independent Business), small businesses have ranked the cost of health insurance as the most critical problem they face. The link between health costs and employment is increasingly clear. A study shows that industries that provided health care to more of their workers in 1986 had significantly lower employment growth between 1987 and 2005.
Could bribery and political corruption also be behind Medicare and hospital billing fraud?
The top 2 U.S. counties in which doctors billed the highest percentage of the two most expensive Medicare codes for established patients in 2008 were in Republican Florida Governor Rick Scott's state of Florida.
Governor Rick Scott (who was once accused of Medicare fraud) recently suspended Miami Lakes Mayor Michael Pizzi and Sweetwater Mayor Manuel Marono from office after they were both arrested by the FBI on public corruption charges for taking bribes (Both mayors are Republican, but the pending charges are not yet clear). U.S. Attorney Wifredo A. Ferrer said, "Our democracy suffers in these cases when elected officials use their power and political influence for personal gain instead of the public good."
As Mister Rick Scott, he ran a company that paid a record fine for committing Medicare fraud. PolitiFact has investigated claims against both Scott and Romney about Medicare fraud during their business careers.
But as Republican Governor Rick Scott, he cut millions from health care benefits for Florida's poor. Now Florida's chief economist has warned the staff of Governor Rick Scott that his Medicaid cost estimates are all wrong, but Rick Scott keeps using them anyway.
To his rare credit, Mitt Romney has dismissed the GOP strategy of shutting down the government in their efforts to de-fund Obamacare. Bain Capital greatly profits from government contracts. Senators Marco Rubio of Florida (Rick Scott's state), Ted Cruz of Texas (George W. Bush's state) and Mike Lee of Utah (home state of Romney's church) are urging Republicans to swear off voting for any year-end spending bill that includes money for the president's health care law. Parts of the federal government would shut down on October 1st if Congress doesn't approve a short-term funding bill before then.
As an aside: Mitt Romney also opposes Obamacare because of the 3.8% surtax on his capital gains to fund Obama's healthcare plan. Romney earns, on average, about $20 million a year from capital gains on his "deferred interest".
* See my post: Fraud, Greed & Profits Drives Healthcare Costs