DOJ Charges 19 Defendants in Philadelphia Medicare/Medicaid Fraud Scheme

Our government budget is 90% fraud.

The specific fraud type is yet again a Democrat creation. The Democrats wanted to pay people for "home health care" -- basically a non-medical-professional person dropping by someone's house and getting paid for it.

It turns out that in 96% of the cases being charged here for fraud, the exact illness the "patients" were supposedly being treated for is "illness unspecified."

Yeah I'll bet it's unspecified.

Why? Because if you're defrauding the government, it's easier to say "I don't know why I'm sick" then get an actual diagnosis from a doctor.

Not that you can't pay a corrupt doctor to submit phony diagnoses. That's a cornerstone of this industry the left has created to steal money from actual workers.

But an actual illness could be expected to heal at some point, or kill the "patient," and it's just easier to claim you have some unknown, unidentifiable malady, who knows what it could be. All you know for sure is that you need the government to pay your husband $50,000 to "care" for you.

DOJ charges 19 defendants in alleged $4 million Philadelphia Medicare and Medicaid fraud scheme

In one case, a Medicaid recipient filed claims for extensive home health assistance while also working as a carpenter, prosecutors said.

Federal and Pennsylvania authorities charged 19 defendants who are accused of participating in a $4 million scheme involving Medicare and Medicaid claims.

Among the defendants are home health care company owners, their employees and Medicaid recipients, Fox News reported.

Pennsylvania Attorney General Dave on Sunday announced a plea agreement involving a defendant in a separate case in which 21 people were charged with fraud involving more than $1.7 million in claims.

The defendants are alleged to have billed Medicaid for home health services while they were incarcerated, hospitalized, working other jobs or traveling overseas. In one case, a Medicaid recipient filed claims for extensive home health assistance while also working as a carpenter, prosecutors said.

Other defendants are alleged to have submitted overlapping or impossible work hours, such as care that exceeded 24 hours in a single day.

Eric Daugherty @EricLDaugh

1h

🚨 HOLY SMOKES. In a massive revelation of fraud in Pennsylvania, Dr. Oz just confirmed that over 96% PERCENT of personal care claims are "illness unspecified..."

...which makes them UNTRACKABLE

The average payments per beneficiary: "More than $50,000. Think about that. PER PERSON. FAR above what's expected."

"Over 96% of personal care claims here are 'illness unspecified.' That's how they're titled, so we can't track them....can't possibly find the fraud because people aren't telling us what they're doing!"

"All of this points to FRAUD."

QThestorm
@17QStorm

🚨96% OF PENNSYLVANIA'S PERSONAL CARE CLAIMS ARE LITERALLY UNTRACKABLE

Dr. Oz just dropped the hammer live.

Over 96% of the claims are coded "illness unspecified." No diagnosis. No details. Nothing the system can audit.

Average payout per beneficiary: more than $50,000. Far above anything that makes sense.

He said it straight: "That's how they're titled, so we can't track them... can't possibly find the fraud because people aren't telling us what they're doing."

"All of this points to FRAUD."

This is how the machine loots taxpayers in broad daylight -- hide the illness, cash the check, repeat.

Trump's CMS is finally shining the light. The swamp hates it.

Apparently the code for "unspecified illness" is to be used only when there is some unidentifiable complication that comes with an actual identifiable illness, and they're doing tests to find out what the other complaint might be.

It's not a permanent diagnosis. It means "we're working on it."

But fraudsters are using the code as the main, final diagnosis:

Salt ✟ Light @SaltandLight70

The ICD-10 code R69 illness unspecified should never be used as a principle diagnosis. It is used in conjunction with the primary symptom code, with R69 as add on for diagnosis unclear at the time of clinical evaluation, additional testing, consultation or workup pending. So just reject payment for all bills using R69 as principle diagnosis.

posted by Disinformation Expert Ace at 01:20 PM

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