Comes as no surprise from here in the land of “Massive Resistance.”
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Heh. Then you work with amateur coders. My former associates are professionals. They’d figure out a way to code this so it’s a new admission. Yeah, they used to get caught occasionally, but never seriously, and the fines are just a cost of doing business with the USG. I don’t miss that at all. It’s different here in Europe, and I much prefer it this way.
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Woah… Y’all have medicare in europe!?
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Nope. Elder care is all lumped together as just another piece of what we call Social Security (which is considerably different than the old-age pension and disability benefits that the US calls Social Security.)
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So … how is it possible to tell the difference between “billing fraud which is criminal malfeasance” and “billing fraud which everyone has to do pretty much all of the time because it’s the only way to get anything done, let alone any hint of equity”?
It seems to me to be saying that people who are guilty of horrible crime A are usually convicted of much less serious crime B … when the statutes for crime B are written so badly and so broadly that almost everyone is guilty of breaking those laws most of the time, and if the authorities want to break someone, high or low, all they have to do is start with an accusation of committing B, be guaranteed a conviction, and work from there.
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It’s not. The GOAL is to deny people coverage, to punish the poor for being poor.
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You know why people from outside the US keep telling you that your medical system is fucked, as if you didn’t know it?
It’s because, as bad as we think we know it is, we’re never truly prepared for how deeply, systematically, foundationally, fractally fucked up it actually is.
Think of our helpful reminders less as helpfully telling you, and more us disbelievingly repeating it to ourselves. That’s screwed up. That’s fucked up. That’s … oh geez, that’s fucked.
And there is no bottom.
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You’ll forgive me if I’m over cynical. I am, and I know it. But who gets seriously prosecuted seems to be dependent on how big the company is, how well they can defend themselves, how “in” they are with the current government, and how good their medical coders are. Deniability is all.
The most common Medicare prosecutions are usually sole practitioners or small physician groups that are greedy and blatant about it. That makes them easy to prosecute. Larger medical groups, hospitals, and secondary providers (labs, radiology providers, and so forth) get fined from time to time but seldom seriously and are almost never criminally prosecuted. Everyone sees it as just the cost of doing business.
A lab I worked for years ago got nailed for the biggest fine ever (at the time) and the CEO went to jail briefly and got a Medicare “death penalty”: banned for life from providing services to Medicare. But they had been defrauding Medicare for years and for billions. The lab closed, “merged” with another lab, and opened again under a new name and they got much better at the grift. They also ratted out all their competitors who were doing the same thing. At the time (I don’t know if it’s still true) the whistleblowers got a piece of the fine, often enough to make up for the fact that they’d never work in the industry again.
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Yeah. I fucking know it’s fucked. I live here. 
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There’s a pretty simple solution to most of it, though. Single-payer. Eliminate private health insurance and run everything through Medicare. Because most private insurers won’t really react to billing fraud as long as they can pass it on to their customers (their max profits is limited by their spend, so the more they spend, the larger the profit), the entity hospitals are afraid of is Medicare. They will go after you (and your family and friends and your dog and cat, too).
A nice side effect will be eliminating GPOs. If there’s only one payer, there’s only one price and the whole reason GPOs exist goes away.
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And instead of Billing being the largest cost center, and Coding being the second largest, those employees can actually do productive work instead of pushing paper.
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Yeah, well… it’s WAY worse having to actually try to live with it on an everyday basis.
RIGHT???
This is not something we don’t already fucking know.
No one is more aware than those of us who bear the brunt of the burden in perpetuity…
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And we keep trying to fix ALL OUR SHIT, but we have a not insignificant number of people who are actively subverting that, some of whom are pretty powerful. It’s not like we’re not fucking trying over here.
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tl;dr
Patient dumping violates existing U.S. law.
Patient dumping is financially rewarding for hospitals.
Patient dumping will continue as long as penalties for doing so are minimal, or financially net-positive, and it continues to be impossible send a corporation to jail, despite the claim that “corporations are people” inside the U.S.
ETA:
This.
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The “under new management” / rebranding / corporate merger / corporate spinoff will ever be the escape hatch that The Greed Community uses to perpetuate its endless grift.
It’s a dang miracle that the CEO went to jail for any time at all, really. I am sure that person felt it was entirely worthwhile considering the astronomical profit.
Meantime (with emphasis on “mean” as in “petty” as well as “cruel”)… people die. Monetizing human misery is a very old game.
Small mercy then there are whistleblowers.
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