Medicare fraud: ‘It all starts with the doctor’


This morning, I read this short article in the Houston Chronicle about a doctor on trial for allegedly filing $5.22 million in phony home health care claims by selling his signature over and over again.

“Dr. Ben Echols, a New York-educated gastroenterologist, is charged with accepting cash in exchange for helping Family Healthcare Services file fraudulent claims to Medicare, the nation’s largest insurer for the elderly,” the article reads.

(BTW, why does it matter that this doc was educated in New York? Is that supposed to carry some weight of some sort?)

Normally, I would have stopped reading at home health care claims. That’s a bit outside our scope. We cover home medical equipment providers, not home health agencies. Theresa, Elizabeth and I have only so much time.

But for some reason (delaying the real start to my work day, perhaps), I kept reading. And I’m glad I did.

It turns out, during the trial, a federal prosecutor told jurors: “It all starts with the doctor, and the doctor has the final word.”

Priceless, right?

See, Family Healthcare Services, whose owners have already pleaded guilty for trying to defraud Medicare of the $5.22 million in phony home health care claims plus $1.1 million in phony DME claims, is pointing its finger at the doc as the central player in the scheme. And the government’s running with it.

Say what you will about the motivation of Family Healthcare Services (I typically don’t like it when people blame others for their actions), but I’m not going to question it in this case.

Because let’s face it, if there weren’t a doctor willing to sign charts without seeing patients, where would Family Healthcare Services be? Well, worst-case scenario, it might be onto its next scheme, but at least it would be discouraged.

I’m not saying there aren’t instances of Medicare fraud where DME providers deserve to be the sole focus of the government’s burning attention. Remember that scheme where they were using the ID numbers of dead docs to file claims?

Many times, however, these schemes wouldn’t be possible without the involvement of a doc. If you want to get paid for DME by Medicare, you need a prescription and other documentation from a doctor.

Yet, from what I can tell from my little office in Yarmouth, Maine, the government continues to focus its efforts on DME providers. If, in the process of prosecuting them, it can also prosecute the doc involved, that’s an added bonus.

What I want to know: Why not nip this thing right in the bud and go right after the doc?

There are all sorts of answers to this question—the most frequently cited: that the docs have a big lobby that protects them from taking too much heat—but at least, here, we have a government official admitting in a public setting that fraud starts with the doctor.

It’s a start.



Good story, however, the reason the Doctors are so protected as told to me by an OIG Attorney is because "the world needs Doctors but DME Companies are of a lesser value and importance in the delivery of health care.  It is also much easier to replace the DME Company than the Doctor.  The OIG Attorney referred to DME Companies as "a dime a dozen"!

This is part of the reason I had written the comment the DME Industry needs to become a Federal Licensed Provider.  It would strenghten the position of the industry Providers in many ways.