Congress is obsessed with Medicare/Medicaid they view it as a tool for the devil. They may be right but wrong devil. Congress is sure any oldster or lower/under/unemployed person needing medical care and relying on the Government to pay the bill is some type of shirker or faker. They want to stop this like non existent voter fraud and in turn give grants to States to administer their own type of "welfare."
I can see that working out like privatized prisons. Those worked out great! Or how about Charter Schools? Or Ambulance or Fire Fighters! Soon we will have Private Cops like those in foreign countries that did such a great job in the Middle East. Remember Blackwater?
I have fond recollections of the demands that private industry can do it better. No they do it for money, profit and little else. Anyone who believes that the Silicon Valley does anything to make the world better needs to find a mental health counselor covered by insurance. Oh wait.
This is who exploits Medicare and Medicaid. This Doctor who defines fraud. The Big Pharma CEO's who find ways to jack up prices for life saving drugs, for simple inoculations for those who need help but can't afford it. We are all collateral damage in the quest for profits.
Want to know why we have an opioid crisis in this country? Ask them - the Industrial Medical Complex.
The pill mill doctor who prescribed thousands of opioids and billed dead patients
By Kristine Guerra
The Washington Post
September 22 2-16
A former Michigan doctor who ran a pill mill for 16 months, distributing tens of thousands of narcotics and controlled substances to people who didn't need them for medical purposes, has agreed to pay $200,000 to settle a federal lawsuit that accused him of, among other things, falsifying records to charge dead patients, subjecting patients to unnecessary tests and billing for office visits that never happened.
The settlement was announced Wednesday, amid National Heroin and Opioid Awareness Week, and came nearly four years after Hussein Awada, 46, was accused of defrauding Medicare, Medicaid and Blue Cross Blue Shield of about $2.3 million. He was charged in December 2012 of unlawful distribution of a controlled substance and conspiring to commit health care fraud. Awada pleaded guilty and was sentenced last November to seven years in federal prison.
In 2013, a separate civil lawsuit accused him of defrauding government programs — a violation of the False Claims Act. The lawsuit was filed in federal court in Michigan.
Investigation into Awada began in 2011, after his former receptionist alerted the Drug Enforcement Administration about his medical practice.
From 2010 to early 2012, federal prosecutors said, Awada wrote prescriptions, without any medical justification, for 80,000 doses of Oxycodone, Roxicodone and other painkillers to groups of patients who were recruited by a marketer. The marketer, James Lyons, then bought the pills from the patients he recruited and resold them to street drug dealers.
Court records said Awada also required new patients to undergo unnecessary tests and procedures, such as ultrasounds, blood work and X-rays, even before they'd been examined by a doctor. Awada then billed Medicaid for those procedures.
In some cases, Awada falsified records to bill Medicare for services that either never happened or were provided to patients who had died.
A witness told investigators that Awada once said "I know X-rays are a pain, but they are our money maker, what pays your check," according to a criminal complaint.
During Awada's sentencing hearing last November, Assistant U.S. Attorney Lynn Helland said he contributed to Michigan's opiate epidemic.
"He contributed in a very large way for a period of at least two years," Helland said, according to a transcript of the hearing. "He did that as a doctor with a license, who, of all people, should have known the impact his prescribing was having on a broader community."
Dr. Hussein Awada leaves federal court in Detroit on Dec. 12, 2012. (Daniel Mears/The Detroit News file)
Aside from the prison sentence, Awada also was ordered to forfeit his assets to help pay $2.3 million to the government, according to the Justice Department.
That's separate from the $200,000 he agreed to pay to settle the civil lawsuit.
"This settlement demonstrates that doctors pay a substantial price when they seek to profit by prescribing medically unnecessary prescription drugs and services that may harm their patients," Barbara McQuade, U.S. attorney for the Eastern District of Michigan, said in a news release.
Awada's attorney, Steve Fishman, said his client has paid nearly all of the $2.3 million in restitution. Had a settlement not been reached in the civil case, Awada would have been required to pay more than $4 million in damages, Fishman said.
"Dr. Awada wanted to settle the False Claims Act lawsuit so that when he comes home and goes back to work, he will not have this hanging over his head," Fishman said.
Awada, whose license was revoked, had been a medical doctor since 2002. Fishman said Awada, who owned a clinic in Warren, Mich., can try to get his license reinstated after he has served his sentence.
Lyons, the marketer with whom Awada conspired, was sentenced to four years in prison.
During his sentencing hearing, Awada said he was ashamed of his actions.
"I assume full and complete responsibility for my actions. I deeply regret the shame I have brought to my family. I just put them through so much pain," Awada said, according to a transcript of the hearing. "I apologize for the patients who I may have caused harm and who I have hurt by these actions."
Awada has five children. He is also the brother of a former economic development chief in Wayne County, Mich., according to the Detroit News.
The settlement was announced one day after Attorney General Loretta E. Lynch spoke in Kentucky about the urgency of the opioid epidemic.
"What we face is not just a law enforcement crisis or a public health crisis," she said. "We face a moral crisis — a test of whether we in the United States can protect our children, our friends, our neighbors, and our fellow citizens from the scourge of addiction."
The opioid epidemic, she said, "erodes opportunity and diminishes public safety. It undermines our communities and tears at the fabric of our common life as Americans."
"Addressing this crisis is about helping our neighbors," she added. "It’s about looking after our friends. It’s about saving our children. It’s about taking care of our own. And that’s who we are as Americans – that’s what we do in times of turmoil.
A new federal study found that more than 1 in 3 American adults, or 35 percent, were given painkiller prescriptions by medical providers last year. The report by the Substance Abuse and Mental Health Services Administration states that in 2015, prescription painkillers are more widely used than cigarettes, smokeless tobacco or cigars, combined.