Reporting Medicare/Medicaid fraudulent billing

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244-Print-Friendly.pdf

What Is Medicare Fraud?

Knowingly ordering medically unnecessary items or services for patients

What Is Medicare Abuse?

Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.

We know that both the FDA and Pfizer does not approve – or discourages – the use of Methylprednisolone and similar cortisteroids to be administered as epidural spinal injections (ESI).

How many pts have been told that they must get ESI in order to get oral opiates… even if previous ESI’s have provided little/no pain relief.

How many pts have been given additional ESI because the insurance will “pay for it again”.. after the pt has been told that the procedure will provide some pain relief for months, but in reality the pt is lucky to get some pain relief for days or weeks.

It has become rather routine for the DEA to charge prescriber’s offices that they have raided with “Medicare/Medicaid fraud” because the DEA has determined that the prescriber provided oral opiates that were not medically necessary.

It is estimated that 10 million ESI are provided to chronic pain pts EVERY YEAR and abt 5% will contract adhesive Arachnoiditis https://www.practicalpainmanagement.com/pain/spine/arachnoiditis-part-1-clinical-description

Pts can call 800-MEDICARE to file a complaint but I doubt if they will take a complaint seriously… I doubt if those employees of CMS are interested in anything that would cause a downsizing of their agency.  More action and attention may be achieved by contacting the pt’s Federal  Senators and Representative.

 

 

One Response

  1. Shouldn’t it be the other way around? That the office should be charged for forcing the ESI’s on patients who get little to no help from them, and not be charged with giving patients opiates that are helping? It’s the ESI’s that weren’t medically necessary!

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