Medicare Compliance & Reimbursement

The answer may surprise you.

In reality, healthcare may have become a lucrative new stomping ground for organized crime, say some legal experts.

Attorney Robert Markette Jr. says he has, in fact, been claiming for the past couple of years that healthcare fraud perpetrated by organized crime is on the rise.

"What we're seeing in Houston, Miami, and Louisiana is outright criminal conduct where witnesses, etc., are ending up dead," says Markette, in Indianapolis, Ind. "It's like 1920 Mafia stuff." He's also heard anecdotal accounts about foreign Mob elements opening up a home health agency to bill for non-existent services by using stolen identifiers from Medicare patients.

As a result of such actions, "law-abiding healthcare providers are being hammered and portrayed unfavorably in the press," Markette says.

"There are more 'evil doers' purposefully defrauding Medicare" who set up storefronts and bill for services they didn't render, agrees attorney Michael Cassidy, in Pittsburgh, Pa. "Because Medicare pays within 30 days, the government doesn't figure out there's anything wrong until it's too late," he observes. "The system is easy to manipulate" in that way.

But Cassidy doesn't believe "there are as many haphazard or negligent violations by providers." And that's due to the available amount of education on compliance issues, he says.