Friday, January 22, 2016

WDT: US Attorney say Docs Caught With Hand in Cookie Jar

      Local doctors and their billing company have been ordered to repay a million dollars improperly billed to the military iinsurance system called Tricare. according to the US Attorney.
      The docs are at Samaritan Medical Center.
       Theres so much money going back and forth in medicine, it's hard to know if a million is really a big deal, but improperly making a claim is, and the US Attorney caught these folks.
http://www.watertowndailytimes.com/news03/samaritan-er-doctors-with-help-of-outside-billing-company-skimmed-1-million-from-tricare-20160122 

30 comments:

Anonymous said...

At least they dinnit do it "for profit".

Anonymous said...

The leadership team must be exonerated immediately. Full investigation to clear the air.

Anonymous said...

But no names..lol

Anonymous said...

Samaritan spokeswoman strangely silent on the subject. Howcum. Surely coworkers and boss should have known.

Sure isn't silent on Facebook---trivia, drool, and more "look at me, look at me" than anyone should be subjected to; really an embarrassment to SMC.

Anonymous said...

AT THIS POINT does anyone blame them. With the AG being the Political arm of the Democratic Party why or why do we still wonder
why and how the fradulent applications for these Obamacare sign up, the remittance of subsidies that have not been verifired of either citizenship, income or work verification gets a pass.

What we h ave is the most corrupt administration in recent history all lead by the President that was going to part the oceans because he claimed he was God.

Maybe the corrupt AG Dept. should at least open an investigation as to how El Chapo was in possession of a gun that was passed over the border by the previous Fast & Furious author Eric Holder and his boss.

Anonymous said...

SMC Board:
What did they know and when did they know it?
So much for Board oversight!

So much for their on-site multi-million dollar management. Oh wait, should be Wellesley island management.

Where is Mabel when SMC needs her?

Anonymous said...

Hard to believe Samaritan didn't suspect something.

Anonymous said...

Medical billing is a racket, its is interesting that individual providers had a say in their Tricare billing and not Samaritan. I thought that Samaritan handled all the billing for its Drs.

Anonymous said...

How is it that they can refuse to identify the physician group?Shouldn't people be allowed to know if they are participating in fraud and able to make an informated choice whether to patronize them or not?

Anonymous said...

This is not a problem. If we get Bernie, this kind of spending will not even be noticed. We got it. And if we get the pant suited criminal, these bucks will flow to the Clinton Foundation. Either way, who cares?

Anonymous said...

Place is just a negligent on it's care of patients. Misdiagnosed my mother and after rushing her to University hospital in Syracuse she was sent home the next day with proper medication and is fine now.

But keep building an empire and paying your CEO 750,000+ annually just so you can lose sight of your real mission.

Anonymous said...

Um yeah 855, I blame all crooks for their deeds. Unlike your type who doesn't blame someone who criminally uses the bankruptcy laws to profit. :)

Anonymous said...

9:18 - how can you even begin to impugn the Board for this??? Shame on you. They have and are maintaining oversight standards consistent with what we all have come to expect.

It is the little people who caused this and it is the little people who shall pay with their jobs. When they are gone there will be more profits to share for the rest of us (oops, I mean the rest of them).

As for commenting on it - better not cause it will then just go away sooner. More white wine on Wellesley!

Anonymous said...

Heard in the ED waiting room and paraphrasing Marie Antoinette: "let them all wait".

Could setting up fraudulent billing take longer and thus be a contributor to 8-10 hours admittance times?

Anonymous said...

They coded my visit there at 2 different rates - because it bled in from daytime to evening. Whose fault is that?? You're in the ER for eternity, I avoid it if at all possible.

Anonymous said...

Spokeswoman silence?
Check out her facebook page.

Immature, more grinning pictures of her than are necessary---even for someone in love with herself.

She didn't post anything about her marriage. If she reads this, perhaps she will. Her coworkers are waiting.

Anonymous said...

Don't they have an in-house watchdog in the person of a white haired lady who has been known to offer her wrath?

Anonymous said...

WHat is the Bull's take on this.

Anonymous said...

This is funny, in an odd sort of way: Remember when the County DSS czar, and the County Administrator secured millions of Dollars for the County of Jefferson in the form of payment from Medicare, and one of the Contractors the county used told them there billing it wrong, she complained to much and former Leg Gary F.. had her county contracts cancelled, she then blew the whistle on them, and the county of Jefferson had to pay back all the money, and the whistleblower got 10 million, so the hospital took 1/10 of the money the county did....

Max Volume said...

The truth is the DOCTORS don't bill anyone at all, they simply provide their contractual service and other folks take care of the details. I'm quite sure their paychecks didn't have a little asterisk that read, "Here's your skimming bonus...THANKS."

Anonymous said...

As Is the case at many hospitals , the ER is contracted out to a private company and in this case a separate Private company bills for services rendered ,not the docs ,
These are NOT hospital employees , MANY hospitals contract out ER services and ER doc are employed by the contractor NOT the hospitals who operate under thismfor. Of arrangement .

Anonymous said...

This billing fiasco is all part of Obamacare. Remember a year or two ago when the same thing happened to Carthage Hospital. The object is to close all the little hospitals but sometimes even the big hospitals get confused into making a mistake too. The difference is that the bigger hospitals can afford to pay any fines.

Anonymous said...

Jeff - please link the WWNY story here. These doctors got pounded on this blog and others based on WDT article. However, it seems John Moore did a bit of fact finding and found the the US Attorneys office admitted that their investigation showed that the doctors did not knowingly receive this money! This was a billing error in a very complicated medical system, which oh by the way dealt only with Tri-Care which is the insurance for military. Remember the big dog and pony show in March to keep Fort Drum off Sequestration list; one of the big selling points was out so called model whereby we are the only base with off base hospital. That's true, but it als creates unique billing that doesn't exist in other areas. It was a mistake. They are paying it back. However, seemingly much to the dismay of bloggers and WDT there was no back room scheme of how they would defraud the government like cunning little skimmers as the WDT portrays but hey a " billing mistake" isn't as juicy of a headline.

Anonymous said...

Why did the other 11 or 12 practices in the area stop using the wrong codes back in 2010 or 2011 when it was found that they didn't qualify? Did they just have a better billing company that was actually in touch with NY law versus Maryland? I guess that must be it.
The government sends out multiple copies of the same directives to multiple people in any organization and I don't believe for one solid minute the fine doctor's of ER didn't know they SHOULD stop using the modifier. Not surprised that Samaritan is circling the wagons though as they must cover their a$$s at any cost and imagine how many brain cells would be burned trying to replace the current ER group. A $750,000 salary and all the white wine they can get to Wellesley isn't going to make that happen. Didn't we just read what great community members they are, all the volunteer work and contributions....now we know why they can contribute and have all the time off to volunteer...they are ripping the community off and then giving it back...only at SMC.
And then let's talk about how SMC came to the rescue of the Children's clinic when they had their billing issues. If memory serves me correctly, over $500,000 that was never rebilled correctly. They just wrote it off (your taxpaying $) and farmed the billing out to, oh no, a Maryland company. Wonder if it is the same one? Good jobs for Watertown, gone to Maryland. That's what they get paid the big bucks for. Imagine the cases of wine that that company must have sent to Wellesley.

Anonymous said...

Krista?
Too busy self-adoring on Facebook.

Anonymous said...

Does SMC pay for their CEO's commute across the TI Bridge.

Cost of living high on Wellesley!

Is CEO the car-man, or is Mrs. CEO?

Anonymous said...

hey 8:50 - how do you know the other practices stopped using the multiplier? Careful on that one. Also The US Attorney general concluded through a thorough investigation that these doctors didn't knowingly receive the funds. These are the guys whose job it is to prosecute people who defraud the government and yet these guys said the doctors didn't know - but apparently you know differently. Stop with the conspiracy theory. Also, if you really want to get fired up by something lets contemplate the fact that for 7 or more years - Tri-Care - who you and I both fund through our tax dollars, didn't know that they were paying too much in bills? Do they have no culpability in this? I mean should they not known that the code changed? Were they in on the scam ? Or could it be that maybe, just maybe, the change in status was not communicated very well by the government to the various billing companies, medical practices and even Tri-Care? Could it be it fell through the cracks? do you check your bills before you pay them? Should our government not know what the are required to pay? How did they makes these erroneous payments for such an extended period of time. Could it really just be a mistake? But alas that is not as juicy as scammers defraud government on back of soldiers as you would like to think.

Danny M. Francis (Eyepublius) said...

My best advice to anyone using Tricare (which I do not like but have coverage nevertheless) and Medicare (if by chance covered by both for age reasons) I say check and double check your statements. That is critical. I have in the past seen questionable entries for services/Rx/Etc. Challenge them and keep good records.

I saw one of my bills with 3 different doctors listed as getting part of the payment, but I only knew about one of them .. my main provider and then found out the X-ray MD, Lab MD, et al were included - and then it made sense ... caution and checking is a must.

Anonymous said...

Sorry you don't like Tricare, Dannie. It's better than most folks get, but we certainly do not want you to be dissatisfied. Maybe, if Thighs gets elected, we can create another layer of government that makes things easier and cheaper for you.

Anonymous said...

Whenever gigantic sums of money is involved, whether it be government, school, and now healthcare, expect large amounts to be skimmed for personal use. We should expect this with large tubs of taxpayer money. Enjoy. Let's grow government some more.