“Our Medicare system is an honor system, and there’s not much honor left in the system.” Says, Tim Menke, Office of Inspector General, Department of Health & Human Services (HHS)
In this disturbing Medicare fraud investigation by ABC News Chief Investigative Correspondent, Brian Ross and Investigative Producer, Megan Chuchmach enlisted her 82-year-old grandmother, Doris Ace, to go undercover revealing alleged Medicare fraud. Ultimately Ms. Ace was named one of ABC News’ five winners of the Alliance for Women in Media Gracie Awards.
The investigation used hidden cameras and an 82yo undercover grandmother to see firsthand to see how all that fraud happens.
Her simple trip to the doctors resulted in a diagnosis for illnesses that don’t exist, and expensive treatments and supplies that aren’t needed. McAllen, Texas, it’s been called, Medicare Dollarsville. Doctors are getting rich there. Getting rich off you and me.
To see how it works, ABC went into McAllen undercover with an 82 year old grandma, Doris Ace, accompanied by her granddaughter, Investigative Producer Megan Chuchmach. Like any senior citizen, this undercover grandma represents a potential windfall for home healthcare companies, IF a doctor will certify the need for home health care and if there is a medicare number to bill.
Other than some hypertension and arthritis, Doris is a healthy woman, even doing some golfing and line dancing at the local senior center during her Texas visit. Home healthcare recruiters and home healthcare companies, including one recruiter who brought Doris to a doctor he chose for her.
During the doctor’s interview, which is taped, Doris admits she’s in great health. Instead, the doctor’s diagnosis sheet showed Doris to be in terrible health. On the patient referral form, signed by the doctor, a certification saying the patient was home bound, unable to safely leave home unassisted, requiring assistance for all activities. This sort of diagnosis can open the door to huge fraud involving home health care. “It’s worth tens of thousands of dollars a month.” says Gerry Roy, Office of Inspector General, Department of Health & Human Services (HHS)
The next day a nurse from the home health company arrived to treat Doris for a variety of ailments, including diabetes which she doesn’t have. At the end of the month the home health company charged Medicare a shocking $1,767.84.
For the entire interview, including the doctors response to this report, watch the entire story here ~
“Rather fail with honor than succeed by fraud.” ~ Sophocles
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