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Related: Editorials & Other Articles, Issue Forums, Alliance Forums, Region Forums$14 Billion Medicare Scam by Quest & LabCorp exposed
March 23, 2012 /PRNewswire-USNewswire/ -- Quest Diagnostics Incorporated (Quest) and Laboratory Corporation of America (LabCorp), the nation's two largest laboratories, are currently involved in a multi-billion dollar Medicare scam, according to a lengthy and critical expose published in one of the medical laboratory industry's leading trade publications.
The Dark Report revealed recently that the two labs have billed the federal government $14 billion in questionable Medicare fees over a 10-year period and that the practice continues today.
This long-running Medicare and Medicaid fraud has generated billions in profits for the companies, turning them into market leaders at taxpayers' expense, said Karen Hinton, a representative for NPT Associates and Fair Laboratory Practices Associates, plaintiffs in federal lawsuits against Quest and LabCorp.
..."The scam works like this: Quest and LabCorp provide kickbacks to private insurance companies in the form of deeply-discounted and sometimes below-cost lab fees. In exchange, the insurance companies pressure doctors in their networks to send all of their patients' lab work, including Medicare and Medicaid patients, to either Quest or LabCorp. The labs fund the kickbacks (lower lab fees for private insurance patients) by overcharging Medicare and Medicaid patients anywhere from 70% to 500% higher. For example, Quest charged the State of California $8.59 for a complete blood test, but billed private insurers only $1.43."
http://www.sacbee.com/2012/03/23/4360973/medicare-scam-by-quest-labcorp.html#storylink=cpy
Fumesucker
(45,851 posts)I'm told that there will be federal oversight of the medical industry shortly..
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=505960
anti-alec
(420 posts)Seriously....
cbdo2007
(9,213 posts)Just fate?? It is a combination of ACA and whistleblower laws. Otherwise they would have kept doing it.
Fumesucker
(45,851 posts)And let's face it, the whole "whistleblower" thing is definitely a multi faceted situation with the current administration, it has been less than friendly to whistleblowers within government that cause embarrassment or inconvenience.
LanternWaste
(37,748 posts)Seems as though this is indeed a direct result of federal oversight.
However, you may or may not worry at your own pace, as I'm sure we all will regardless of sincere and honest suggestions otherwise...
Fumesucker
(45,851 posts)Eh, it's only 14 thousand million dollars, I'm sure the Feds would have caught them eventually.
ProSense
(116,464 posts)notice that the link in your first comment is related to the health care law and not to Medicare?
"Eh, it's only 14 thousand million dollars, I'm sure the Feds would have caught them eventually."
Yes, the health care law strengthened federal oversight, including oversight of Medicare.
Texas TBagger Doctor Indicted In Largest Medicare Fraud In History
http://www.democraticunderground.com/?com=view_post&forum=1002&pid=361246
Health Care Fraud Prevention and Enforcement Efforts Result in Record-Breaking Recoveries Totaling Nearly $4.1 Billion
http://www.hhs.gov/news/press/2012pres/02/20120214a.html
Fumesucker
(45,851 posts)Which was kind of my point..
I suspect "oversight" will be far more about screwing with some poor schmuck who fouls up his or her forms than it will be about regulating outrageous behavior on the part of insurance companies and medical providers.
Some things are too important to leave to private enterprise, the privatization of the military is a blatant case in point.
KansDem
(28,498 posts)Oh, but don't worry. We still have Social Security and what's left of Medicare to make up for the losses...
joeybee12
(56,177 posts)Not on medicare, though.
Scuba
(53,475 posts)... that's what my Republican Senator said.
Frustratedlady
(16,254 posts)were on-going or just beginning during the Bush administration. Particularly, the ones in Florida. There have been quite a few uncovered in the last few months/year. I wonder IF they recover the money or are paid the fines and where that money goes. Does it go to lower the debt in Medicare/Medicaid or into the general fund?
avaistheone1
(14,626 posts)zipplewrath
(16,646 posts)Not in the classic sense. It stinks to high hell, and there's a good possibility that they ran afoul of the law somewhere. But what they were doing was basically negotiating a "loss leader". In most government contracting though, there is a restriction on this kind of "cost shifting". Without seeing all the pricing structure it's hard to figure it out. What we will probably hear though is that this practice will be terminated by the government, one way or another.
My company has negotiated deals with various providers in which we agree to funnel all of our business to them. In exchange, we get a pre-negotiated price. It isn't the lowest, but it's not the highest either. We get several benefits from it, one of them being priority as well as "guaranteed" service. One of them is with a car rental company. We are guaranteed a car when we arrive. What that means is that they'll give us any car they have to serve the reservation. And they'll basically "screw over" individual retail customers to give it to us (they'll give us a car they were holding for another reservation if they are running short). I've seen it in action. Went into Dallas near some big Cowboys game. The sign said "no cars available". I walked up and they first said that they didn't have any cars, I'd have to wait. Then they looked up my reservaton. She call's her manager over and he goes "oh, yeah, well, um, here, give him this one." She responds something about "but that's for, um, well, see, this guy, and look at the rate!". Yeah, I know, gotta do it though" was the response.
What is amazing in this situation is that the GOVERNMENT hasn't negotiated these deals. They gotta be a huge customer. So you'd think they'd at least negotiate some fairly "low" rates or something. Someone dropped the ball BAD.
gratuitous
(82,849 posts)First, the government has been forbidden to negotiate Medicare rates for services and particularly for prescription medications. Something to do with an overriding phobia about socialized medicine or similar unreasoning fear trumped up by politicians who coincidentally receive a large chunk of money for their re-election campaigns from PACs fronting for care providers and prescription drug manufacturers.
Second, the rental car agreement you're referring to is a matter between your company and the rental car company. It would be far more analogous if your company was being reimbursed for its rental car charges by an outside government agency. The "scam" and it is a scam would be your company rents cars for $25 a day and the rental agency charges you that amount, but you and the rental agency tell the third party reimbursement agency that you're paying $35 a day for rental cars, and then your company and the rental company split the extra $10 a day from every rental.
zipplewrath
(16,646 posts)There was some implication that the "kickbacks" in question were in the form of the reduced cost tests. I couldn't quite follow that.
cbdo2007
(9,213 posts)that they were actually OVERBILLING Medicare for some of the tests, sometimes 4-10 times the correct amount.
zipplewrath
(16,646 posts)The question is how is "correct amount" determined. One would think these things are established by contract, or negotiation. If they were mis-billing their in big-o-trouble.
AtomicKitten
(46,585 posts)SCantiGOP
(13,873 posts)And several years ago we were penalized quite a bit if we didn't have our doctors send all lab work to LabCorp. It stopped several years ago, so I don't know what the story there was.
lsewpershad
(2,620 posts)Of course not...or maybe
Egalitarian Thug
(12,448 posts)lovuian
(19,362 posts)people there are labs which will draw your blood without a Doctors order and the price of the lab work is much much cheaper
a friend of mine was charged 469 dollar for routine checkup lab work ...if she would have had it drawn her self it would have been 103 dollars.....the insurance wanted her to pay the whole 469 dollars ... but when she challenged on it they said she only owed 119 dollars
so you see the scam ....who was getting 369 dollars
oh and she would have paid 103 dollars if she would have paid cash herself which she paid 119 dollars
so do you get it
the Insurance don't pay ANYTHING the idea is to jack up the prices so high that 80% coverage is that you pay for it
yourself and the insurance don't pay anything
insurance doctors and labs .... are screwing people for Billions!!!
and people are figuring it out
notadmblnd
(23,720 posts)My Dr wrote a prescription for Claritin.when I went to get it filled, the pharmacy wanted to charge me 30.00. I saw the OTC stuff for ten. It was the exact same thing.
dixiegrrrrl
(60,010 posts)MagickMuffin
(15,953 posts)So, what's new under the Sun!
quaker bill
(8,224 posts)why my insurance finds Quest to be a preferred provider....