Granny Bird Award: RehabCare Group Inc.

Unfortunately, it's time for another Granny Bird Award, given from time to time to those who make it a point to harm elders in some egregious way. This time it goes to a fraudster, someone bilking our system.

Intervening in a lawsuit by a Minnesota whistleblower, the U.S. Justice Department has sued a large health care company based in Kentucky, alleging that it paid more than $10 million in kickbacks for access to Medicare and Medicaid patients living in a chain of nursing homes.

In a civil complaint filed in Minneapolis, the U.S. attorney said RehabCare Group Inc. began making illicit payments in 2006 as part of a deal with Missouri businessmen who owned 62 nursing homes in their state and an in-house company that provided health services to the residents. The deal was premised on RehabCare's plan to take control of the services and expand billings under Medicare and Medicaid, the complaint said.

"The suggestion was straightforward: Facilities that contracted with RehabCare could expect [it to] provide more therapy to the facilities' beneficiaries, and as a result, the facilities would make more money,'' said the complaint filed by Assistant U.S. Attorney Chad Blumenfield.

The recipient of the alleged kickbacks, Rehab Systems of Missouri LLC (RSM), received an initial $600,000 payment and a cut of more than 10 percent of RehabCare's ongoing billings, which have exceeded $70 million since 2006, the suit said.

The litigation is based on a federal anti-kickback law that makes it illegal to pay others for referrals of Medicare patients. Patients are supposed to receive services based on their medical needs, not as a result of financial inducements paid to their health care providers. The lawsuit seeks fines and financial recoveries. [Emphasis added]

$70 million, much of it for unnecessary treatment. That's a lot of money flowing out of our system. Fortunately, a whistleblower stepped up and reported the scam. We can't, however, always count on some honest soul to do the reporting in each case. Those of us who receive Medicare have a role to play as well.

First of all, we need to remember to guard our Medicare card and our policy number. People offering us a free lunch so that they can offer us some "free tests" don't need either.

Second of all, Medicare sends out regular reports with itemizations of billings they have received for our accounts. We need to read those reports as soon as they arrive and not just toss them as junk mail. If an item appears that doesn't seem right to you, such as a motorized wheelchair when you don't need any such assistance or a diagnostic test you never received, notify Medicare immediately by phone (or on their web site). Medicare adjusters will look into it, and if they see a pattern of such abuse from a provider, they will report it to the Department of Justice.

Third, Congress and the White House keep looking for ways to cut the cost of Medicare. You might let both know that one way to contain costs is to go after Medicare Fraud and to go after it hard. If it means giving more funding to the DOJ, then so be it. The system could save millions every year just by prosecuting and fining these con artists, far beyond what it might cost to fund a special unit to do the work.

We really do need to start making some noise, especially these days.