Justinian Lane

Billions in Medicare fraud – and the tort “reform” crowd opposes measures to fight it

Why does the tort “reform” movement want to make it harder to catch people who defraud Medicare?

WASHINGTON (AP) — The government paid more than $1 billion in questionable Medicare claims for medical supplies that showed little relation to a patient's condition, including blood glucose strips for sexual impotence and special diabetic shoes for leg amputees, congressional investigators say.

Billions more in taxpayer dollars may have been wasted over the last decade because the government-run health program for the elderly and disabled paid out claims with blank or invalid diagnosis codes, such as a "?" or "zzzzz." Medicare officials say even smiley-face icons could have been accepted.

Source: The Associated Press: Probe: Medicare paid billions in suspect claims

One of the most effective ways of fighting government fraud is something known as a qui tam lawsuit.  Qui tam is a shortened version of a Latin phrase that roughly means, “One who sues on behalf of himself and on behalf of the King.”  A qui tam lawsuit is brought by an individual who believes someone has defrauded the government.  If the individual wins, the defendant is ordered to reimburse the government, and the individual who brought the suit gets a portion of the fees.

Most qui tam lawsuits are brought under the federal False Claims Act, which allows the whistleblower to keep usually between 15% and 30% of the recovery.  To be clear, the recovery is fraudulently-obtained taxpayer dollars.  Yet the tort “reform” movement – which purports to act for the good of taxpayers – is very hostile to qui tam lawsuits.  Instead of worrying about the billions of dollars stolen from taxpayers, the “reformers” worry that the lawsuits are too costly to the entities that committed fraud, and that lawyers are too eager to file these lawsuits.

I’m short on time now, but expect more coverage of qui tam later in the week.  Between now and then, ask yourself why the “reform” movement is so concerned with protecting companies that steal from taxpayers.

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Posted at 1:33 PM, Sep 24, 2008 in Health Care | Hypocrites of Tort "Reform" | Right to Access the Courts
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Why file a tort suit instead of prosecuting criminally for fraud? If these claims are suspect, then invesitigate them for what they are.

Posted by: throckmorton | September 24, 2008 1:44 PM

Not sure why it has to be either/or. But given that corporations can just do deferred prosecutions, pay a negligible fine and avoid public attention for their crimes, I'd say that going for criminal prosecution alone is insufficient.

Posted by: Kia Franklin | September 25, 2008 4:56 PM

I'd prefer it if you'd actually spell-out the "Reform" position on something, rather than simply accusing the associated individuals of opposing something carte blanche. Or at least provide a link or something.

I'm sure the official reform position (if there is such a thing) is a bit more nuanced than "opposes measures to fight medicare fraud."

Posted by: Lawyer | September 25, 2008 6:15 PM

Isn't the idea of a mutuality of remedy a basic element of justice and fairness? Why does the government, a wholly owned subsidiary of the criminal cult enterprise, grant itself nearly total immunity from any accountability? This government is the biggest tortfeasor of all, in total failure in all the fundamental duties of government. It totally protects evil, and comes after the productive, all in a bunco operation in rent seeking. They use armed thugs to go after a doctor who upcodes inscrutable procedures. Illegal alien gangs behead people with total immunity.

Posted by: Supremacy Claus | September 25, 2008 9:20 PM

Speaking of Medicare fraud, I am always amazed by the number of patients that come in that are on full Medicare and Social Security disabilty but are able to drive themselves to the office and infact play 18 holes of golf. (apparently, they cant get a job driving or being a caddy). I just had a patient come in for a unrelated reason but in the process of filling out their medical history, they listed all kinds of medical neverland diagnosis that are hard to prove or unprove. The interesting thing was that she was copying them from a handout that was provided by our local disabilty attorney. (our front desk person was nice enough to copy it for her) Sure enough, three days later there was a request for medical records from the disability attorney. Mind you, we did not see her for anything that had anything to do with disability. She and her attorney were just trying to establish a paper trail for a fraudulent claim. How about a class action suit against attorneys who specialize in fraudulent disability claims?

Posted by: throckmorton | September 27, 2008 12:04 PM

As a practicality, lawyers have dealt themselves total immunity. There is no legal recourse against the lawyer and judge profession. When they threaten the criminal cult enterprise, the biggest lawyer is crushed, and he has no legal recourse.

If the public decides to get violent, the lawyer has 99% control of government. Army Airborne will suppress any uprising against the criminal cult enterprise. They run a tighter ship than the KGB.

Posted by: Supremacy Claus | September 27, 2008 6:43 PM