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Medicare fraud whistleblower's story
Old 01-28-2019, 09:40 PM   #1
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Medicare fraud whistleblower's story

Fascinating long-read story on a whistle-blower in one of the largest companies involved in administering/billing Medicare plans.

(Also, a mention of how Advantage Plans can provide ancillary benefits such a gym memberships.)

The Personal Toll of Whistle-Blowing

Why one physician took the risk of becoming an F.B.I. informant to expose alleged Medicare fraud.

"Sewell had joined Freedom, which made most of its money administering Medicare plans, in 2007. The financial crisis was beginning, and employment opportunities were drying up across the country, but the sector of the health-care industry that drew its revenue from Medicare was booming. During his time at Freedom, Sewell had become convinced that the company was defrauding the government of hundreds of millions of dollars by carrying out a sophisticated set of scams targeted at a new program called Medicare Advantage. Sewell, an avid reader of John Grisham novels, had been so appalled by what he observed, and so intrigued by the romanticism of going undercover, that he had decided to become a whistle-blower."


https://www.newyorker.com/magazine/2...histle-blowing

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Old 01-29-2019, 12:38 AM   #2
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Now that was an interesting read.
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Old 01-29-2019, 02:56 AM   #3
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"Sewell quickly noticed many coding inaccuracies, almost all of which were in the company’s favor, resulting in higher government payments. Sometimes, he later alleged, Freedom pressured doctors to schedule unnecessary appointments and to assign additional codes that the internal data miners thought would be more profitable."

Our oldest son, a nurse practitioner, recently separated from a large, cardio-pulmonary practice due to this very type of fraudulent behavior that he, and others, were expected to engage in.
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Old 01-29-2019, 05:37 AM   #4
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Great read. Thank you for sharing this...
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Old 01-29-2019, 05:39 AM   #5
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Quote:
Originally Posted by omni550 View Post
Fascinating long-read story on a whistle-blower in one of the largest companies involved in administering/billing Medicare plans.

(Also, a mention of how Advantage Plans can provide ancillary benefits such a gym memberships.)

The Personal Toll of Whistle-Blowing

Why one physician took the risk of becoming an F.B.I. informant to expose alleged Medicare fraud.

"Sewell had joined Freedom, which made most of its money administering Medicare plans, in 2007. The financial crisis was beginning, and employment opportunities were drying up across the country, but the sector of the health-care industry that drew its revenue from Medicare was booming. During his time at Freedom, Sewell had become convinced that the company was defrauding the government of hundreds of millions of dollars by carrying out a sophisticated set of scams targeted at a new program called Medicare Advantage. Sewell, an avid reader of John Grisham novels, had been so appalled by what he observed, and so intrigued by the romanticism of going undercover, that he had decided to become a whistle-blower."


https://www.newyorker.com/magazine/2...histle-blowing

omni
The guy is very courageous in what he did. Many others would either look the other way or part ways with the current situation.
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Old 01-29-2019, 05:50 AM   #6
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After my mom was diagnosed with her dementia I had her in a locked ALF near me.

Got to know the PA there, then met his wife who was on the delivery floor at the local hospital the same time as my wife.

Not long after the above he got to serve a couple of years in federal prison for Medicare fraud.
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Old 01-29-2019, 07:46 AM   #7
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Take a look at this:
Who says crime doesn't pay? They should be in prison for what they did.
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Old 01-30-2019, 12:39 PM   #8
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Take a look at this:
Who says crime doesn't pay? They should be in prison for what they did.

Amazing...and he has the nerve to say that he's doing good things for the right reasons.

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