|
Medicare fraud whistleblower's story
01-28-2019, 09:40 PM
|
#1
|
Thinks s/he gets paid by the post
Join Date: Mar 2004
Posts: 3,431
|
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
omni
|
|
|
|
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!
Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!
You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!
|
01-29-2019, 12:38 AM
|
#2
|
Thinks s/he gets paid by the post
Join Date: Apr 2016
Location: Dutchess County
Posts: 1,599
|
Now that was an interesting read.
|
|
|
01-29-2019, 02:56 AM
|
#3
|
Thinks s/he gets paid by the post
Join Date: Oct 2013
Location: Cholula
Posts: 1,595
|
"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.
__________________
“Before you criticize someone, walk a mile in their shoes. That way, you’ll be a mile from them, and you’ll have their shoes.” – Jack Handey
|
|
|
01-29-2019, 05:37 AM
|
#4
|
Recycles dryer sheets
Join Date: Jul 2011
Location: Citrus Hills
Posts: 235
|
Great read. Thank you for sharing this...
__________________
DISS-MISSED! work in Dec. 2018
|
|
|
01-29-2019, 05:39 AM
|
#5
|
gone traveling
Join Date: Dec 2018
Posts: 1,196
|
Quote:
Originally Posted by omni550
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.
|
|
|
01-29-2019, 05:50 AM
|
#6
|
Thinks s/he gets paid by the post
Join Date: Jun 2017
Location: Western NC
Posts: 4,610
|
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.
|
|
|
01-29-2019, 07:46 AM
|
#7
|
Dryer sheet aficionado
Join Date: Jan 2009
Posts: 45
|
Take a look at this:
Who says crime doesn't pay? They should be in prison for what they did.
|
|
|
01-30-2019, 12:39 PM
|
#8
|
Thinks s/he gets paid by the post
Join Date: Mar 2004
Posts: 3,431
|
Quote:
Originally Posted by CABarb
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.
omni
|
|
|
|
Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
|
|
Thread Tools |
|
Display Modes |
Linear Mode
|
Posting Rules
|
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
HTML code is Off
|
|
|
|
» Recent Threads
|
|
|
|
|
|
|
|
|
|
|
|
|
» Quick Links
|
|
|