August 3, 2012 by Dave Moore at 12:00:00 am
Medicare fraud costs U.S. taxpayers $60 billion a year, according to Justice Department estimates.
Cortez Mills, a former employee of a Baylor-affiliated physicians group, recently blew the whistle against such fraud, alleging that she was fired from her job at Dallas-based Texas Vascular Associates (TVA) when she refused to double bill and overcharge Medicare, insurance companies and patients.
“Ms. Mills identified what we believe was an illegal scheme at TVA, and she lost her job for refusing to play along,” says Dallas employment attorney Matt Scott of the Kendall Law Group, who represents Ms. Mills. “She had the courage to speak up and recognize this was wrong.”
The complaint, filed on July 26, alleges that when Mills declined her employer’s instructions to participate in TVA’s fraudulent billing scheme, a TVA supervisor responded: “He pays your salary, do what he says.”
Probes into overbilling – referred to as “upcoding” – and other forms of medical billing fraud have uncovered billions of dollars stolen from the federal government and is “one of, if not the most profitable crimes in America,” reports news magazine “60 Minutes”:
…The FBI arrested 53 people in Detroit, including a number of doctors, and charged them with billing Medicare more than $50 million for unnecessary medical procedures.
And in Los Angeles, the City of Angels Medical Center recruited homeless people off the street to fill their empty beds, offering them cash and drugs plus clean sheets and three square meals a day, while billing Medicare tens of millions of dollars for their stay.
“We have to understand this is a major fraud area,” United States Attorney General Eric Holder told (“60 Minutes” correspondent Steve) Kroft.
Mills has taken and passed a polygraph exam indicating that what she says about the billing practices at Texas Vascular Associates is true. In addition, another former TVA employee has signed an affidavit saying she witnessed the same kinds of billing problems during her tenure at the practice.
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