
Feds take down $1B Medicare fraud scheme - prostoalex
https://www.nbcnews.com/politics/justice-department/feds-take-down-1-billion-fraud-scheme-operation-brace-yourself-n992481
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joe_the_user
"An even larger number of patients received unwanted braces sent to their
homes. The unwanted products could disqualify them from receiving a brace
under Medicare if they need one in the future, prosecutors said."

So Medicare knows this happened and is still willing to disqualify random
people from getting braces? Really? I mean, I believe it but still, this is
where we are folks.

It's like someone sued for "damaging" someone's credit, rather than just
demanding that damaging information not being used. It's like an idiot going
to jail for "SWATing" someone but where the SWAT team can still bust down
doors and kill based on random tips.

~~~
r_smart
|It's like an idiot going to jail for "SWATing" someone but where the SWAT
team can still bust down doors and kill based on random tips.

Or getting the wrong house. Remember kids: Limited Immunity means complete
immunity!

~~~
deytempo
If they get the wrong house, there’s always the possibility of them being shot
and killed with no recourse. Any lawyer worth their weight in potato chips
could get charges lifted from someone who guns down unidentifiable armed
intruders entering their home unexpectedly.

~~~
r_smart
Right, but if they gun _you_ down, there's not much that's likely to happen.
They might have to get a job in a different city.

*Edit: Also, not every city has stand your ground laws. And there's nothing stopping them from shooting back and killing you. They're expecting a fight anyway. The lawyer might get a settlement for your family, but you'll still be dead. And your dog too; they love shooting dogs.

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kcorbitt
Ah, so that’s why I’ve been getting so many robocalls that start with “You’ve
been qualified to receive a medical-grade brace”.

~~~
techntoke
Everytime they called me I would try to keep the conversation going telling
them I had pain, and then explained that I had a pain in the arse from them
calling me all the time.

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imperio59
I'm starting to understand why medicare is going bankrupt... Glad these guys
got caught and taken down.

~~~
randomacct3847
Medicare is notorious for being rife with fraud and waste. This ring is far
from the only one.

This includes mom-and-pop doctors who “upcode” certain procedure codes so that
they get paid more. There’s obviously very little the govt can do to check or
know. That kind of stuff happens all the time. Like I wonder if the govt is
even doing basic anomaly detection on claims data to catch these things...if a
ring is getting away with $1bil it makes me think no.

Also...there got to be so much opportunity to build a company around selling a
DS tool to the government or insurance companies to help detect and stop
medical fraud.

~~~
prostoalex
> a DS tool to the government or insurance companies

Insurance companies have actual fraud departments with investigators clinging
onto every hint of over-prescribing, over-billing, over-testing or repeat
visit inflation.

Medicare, on the other hand, has low administrative expense that's constantly
touted as some kind of incredible achievement when compared to those "bloated"
private insurers.

~~~
tehlike
Isnt the 80/20 rule is a disincentive for insurance companies to go after
fraud?

~~~
lotsofpulp
Theoretically, a competing insurance company that reduces fraud can offer
lower premiums. In reality, this is thwarted by having significant portions of
the population locked up in employer provided health insurance so they can’t
shop around, although the employer is sort of shopping around for them. It
would be much better if everyone was dropped onto healthcare.gov.

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ronnier
Why are the criminals not named?

~~~
simonh
The accused. A fine distinction to make in conversation perhaps, but an
important one.

~~~
joe_the_user
It's completely standard for those merely accused of crimes to have their
names spread boldly across the news in America. Nothing protects the accused
in the court of the press and public opinion. I assume if the accused aren't
mentioned here, it's a matter of their having good public relations and good
lawyers.

~~~
mjevans
I assume it's because they can afford lawyers that actually requested the
information be sealed until they're found guilty.

